task sharing – Dr. David Gratzer

From the Editor

He survived the civil war. But nightmares haunted him and he rarely left his apartment. My patient had survived, yes, but his mental health problems, untreated in his home country, tormented him. In a world of war and violence, my patient’s experiences – the mental illness and the lack of care – are all too common.

With few psychiatrists and psychologists, could non-specialist providers help fill the treatment gap? Anushka R. Patel (of Harvard University) and her co-authors attempt to answer that question in an impressive new systematic review and meta-analysis published in Lancet Psychiatry. Drawing on a quarter century of studies and involving more than 10 000 survivors, they compared non-specialist care with a relatively inactive control. “Our findings support the overall effectiveness of non-specialist provider-delivered psychosocial interventions for violence survivors…” We consider the paper and its implications.

In the second selection, from JAMA, Dr. Ezekiel J. Emanuel and his co-authors write thoughtfully if controversially about artificial intelligence. While many assume that medicine will be reshaped by the collaboration of physicians and computers, they suggest otherwise, focusing on five cognitive medical tasks. “That in the near future AI alone may provide better patient care than physicians or physician-controlled hybrids at 5 fundamental cognitive medical tasks is unsettling but seems probable.”

Finally, we review the latest news with articles from The Toronto Star, The Wall Street Journal, and The Globe and Mail. The topics: addiction treatment, the bias of therapists, and the PTSD and research of Margaret McKinnon.

From the Editor

These medications are widely discussed – and, yes, our patients ask about them. But how do glucagon-like peptide 1 receptor agonists impact mental health and overall wellness? Should we hesitate before reaching for the prescription pad?

Aureliane C. S. Pierret (of King’s College London) and her co-authors attempt to answer these questions in a new paper just published in JAMA Psychiatry. In their systematic review and meta-analysis, they included more than 107 000 patients, comparing treatment with GLP1-RAs to placebo, looking at psychiatric, cognitive, and quality of life outcomes in those who are overweight, obese, or have diabetes. “Our results provide reassurance regarding the psychiatric safety profile of GLP1-RAs and suggest that GLP1-RA treatment is associated with improved mental well-being, in addition to the known physical health improvements.” We consider the paper and its implications.

When we hear innovations in mental healthcare, we tend to think of apps or wearables. In the second selection from Quick Takes, Daisy Singla (of the University of Toronto) discusses her recent study that expanded access to psychotherapy for perinatal women, reducing symptoms of depression and anxiety by drawing a page from work done in low-income countries. The key concept: training up laypeople to deliver therapy (task sharing). “It’s one of the largest psychotherapy trials in the world.”

And in the third selection, from The Globe and Mail, Joe Lee writes about his realization that he has depression and that it has affected his life for years. In a personal essay, he talks about his illness and the impact on his life. “Depression is weird like that. For some people, it sneaks in. For me, it’s always been there – like blood in my body.”