Tagglobal psychiatry

Reading of the Week: Cardiovascular Diseases & Mental Disorders – The New AJP Paper; Also, Systematic Racism & Depression (JAMA Psych)

From the Editor

When people with mental health problems have physical illness, how does their care measure up?

Not surprisingly, we worry about their access and follow up. Evidence suggests poorer outcomes. But how do people with mental disorders fare on an international basis?

In the first selection, Dr. Marco Solmi (of the University of Padua) and his co-authors try to answer that question, focusing on cardiovascular diseases (CVD). In a new American Journal of Psychiatry paper, they conduct a systematic review and meta-analysis, drawing on the data of more than 24 million people. (!) They find: “People with mental disorders, and those with schizophrenia in particular, receive less screening and lower-quality treatment for CVD. It is of paramount importance to address underprescribing of CVD medications and underutilization of diagnostic and therapeutic procedures across all mental disorders.” We discuss the paper and its clinical implications.

heart-palpitations

In the second selection from The American Journal of Psychiatry, Drs. Nathalie Moise and Sidney Hankerson (both of Columbia University) consider structural racism and depression care, using a clinical vignette. Rather than just seeing the patient’s experience in terms of genetic loading and medications, they describe a person who has struggled with various forms of racism. They argue: “Mental health professionals need to recognize the effect of structural, individual, and internalized racism on individuals with depression symptoms.”

DG
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Reading of the Week: Shamiri Layperson-Provided Therapy in Kenya – Big Study, But Ethical? Also, a Reader Comments on Chatbots

From the Editor 

There are more psychiatrists of African origin in the US than in the whole of Africa. And I could actually say similar examples from the Philippines, or India, or many other countries. There is an enormous shortage of mental health resources…” 

So comments Dr. Vikram Patel (of Harvard University). Across low-income nations, mental health care services are profoundly difficult to access. Could Shamir (Kiswahili for thrive) – an intervention built on simple psychological concepts and delivered by laypersons – be part of the solution? 

This week, we look at a new paper from JAMA PsychiatryTom L.  Osborn (of Kenya’s Shamiri Institute) and his co-authors describe the results of a study involving adolescents with depression and anxiety symptoms. To our knowledge, this is one of the first adequately powered tests in this population of a scalable intervention grounded in simple positive psychological elements.” We look at the big paper. 

kenya-tanzania-africa-uganda-map-300x200

 But is the work ethical? In our second selection, we consider the editorial that accompanies the Osborn et al. paper. JAMA Psychiatry Editor Dr. Dost  Öngür (of Harvard University) defends the study and his decision to publish it: “Because this trial was already conducted, we considered the obligations of the journal to be different than those of investigators and prospective reviewers. The question for us was whether there is a benefit to society by publishing the study as it was conducted.” 

Finally, in our third selection, a reader writes us. Giorgio A.Tasca (of the University of Ottawa) responds to The New York Times article by Karen Brown considering chatbots. “Is scaling up an intervention with dubious research support – that results in low adherence and high dropout (and perhaps more demoralization as a result) – worth it?” 

Please note that there will be no Reading next week. 

DG  Continue reading

Reading of the Week: Perceived Helpfulness of Depression Treatment – the New JAMA Psych Paper; Also, Friedman on Boredom & the Pandemic (NYT)

From the Editor

How helpful do people find treatment for depression?

This question is broad but new work (drawing on WHO surveys) ambitiously attempts to answer it across different countries, including some that are low income.

In the first selection, we consider a paper from JAMA Psychiatry. Meredith G. Harris (of The University of Queensland) and her co-authors report on WHO data. The good news? Many people do find treatment for depression helpful. The bad news? Many providers are needed for people to believe that they had received helpful treatment.

4anvfzqDepression treatment: helpful, like a lift from a friend?

In the second selection, we look at a new essay by Dr. Richard A. Friedman (of Weill Cornell Medical College). Writing in The New York Times, he discusses the pandemic and the possibility of “a mental health epidemic of depression and anxiety.” Dr. Friedman argues that we are seeing mass boredom, not a rise in disorders like depression. While he can’t fully rule out that the pandemic will bring about an increase in mental health problems, he writes: “let’s not medicalize everyday stress.”

DG
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Reading of the Week: Who is at Risk for Daily Cannabis Use? What Should Every Physician Know About Global Psychiatry? And Hussein on Her Psychotic Break

From the Editor

It’s legal. It’s also addictive.

As clinician, we worry about who may be at risk of heavier use of cannabis. In a new paper published in The Canadian Journal of Psychiatry, the University of Montreal’s Erika Nicole Dugas and her co-authors draw on data to try to identify early risk factors for daily use, drawing on 23 potential risk factors. Their findings are plausible – could the list be used for early interventions?

school-tests

At risk?

Also, this week, we consider my podcast interview with Harvard University’s Vikram Patel, who talks about mental health services in low-income nations. Dr. Patel is fresh off his win of the John Dirks Canada Gairdner Global Health Award, called the Canadian Nobel by some. (I do ask him what he plans to do with the prize money.)

And, in our third selection, singer Ladan Hussein discusses her psychosis – “I returned home to Toronto in January 2018, broken, dishevelled and deranged” – and her recovery.

DG

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Reading of the Week: Psychiatry and West Africa

KPOVÉ, Togo — The church grounds here sprawled through a strange, dreamlike forest. More than 150 men and women were chained by the ankle to a tree or concrete block, a short walk from the central place of worship. Most were experiencing the fearsome delusions of schizophrenia. On a recent visit, some glared, while others slept or muttered to themselves. A few pushed to their feet and gestured wildly, their cries piercing the stillness.

Until this year, Koffi Gbedjeha, 45, a carpenter and father of four, was one of them — a resident of the Jesus Is the Solution prayer camp here, shackled like the others, his family and camp staff members said. For more than two years, his youngest sister, Akossiwa, 27, tended to him. Rising early each morning, she walked along a cool red-earth path to the human forest; each day, amid the stirring bodies and clinking chains, she emptied her brother’s chamber pot, swept the ground and cooked his meals over a charcoal fire.

So begins a series of articles on mental illness in West Africa.

This week’s Reading: “The Chains of Mental Illness in West Africa” by Benedict Carey, which was published earlier this month in The New York Times.

The selection may seem a bit unusual – Readings, after all, usually draw from journals, not from the Sunday paper. But Carey’s reporting is unusually lucid. If you haven’t read his article, I invite you to read it; if you saw this before, it’s worth re-reading.

You can find the article here:

http://www.nytimes.com/2015/10/12/health/the-chains-of-mental-illness-in-west-africa.html?hp&action=click&pgtype=Homepage&module=photo-spot-region&region=top-news&WT.nav=top-news&_r=0

Benedict Carey Continue reading