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Background Digital mental health interventions for smartphones, such as the World Health Organization (WHO) Step-by-Step (SbS) program, are potentially scalable solutions to improve access to mental health and psychosocial support in refugee populations. Our study objective was to evaluate the effectiveness of SbS as self-guided intervention with optional message-based contact-on-demand (COD) support on reducing psychological distress, functional impairment, symptoms of posttraumatic stress disorder (PTSD), and self-identified problems in a sample of Syrian refugees residing in Egypt. Methods and findings We conducted a 2-arm pragmatic randomized controlled trial. A total of 538 Syrians residing in Egypt with elevated levels of psychological distress (Kessler Psychological Distress Scale; K10 > 15) and reduced psychosocial functioning (WHODAS 2.0 > 16) were randomized into SbS + CAU (N = 266) or CAU only (N = 272). Primary outcomes were psychological distress (Hopkins Symptom Checklist 25) and impaired functioning (WHO Disability Assessment Schedule 2.0) at 3-month follow-up. Secondary outcomes were symptoms of PTSD (PTSD Checklist for DSM-5 short form, PCL-5 short) and self-identified problems (Psychological Outcomes Profiles Scale, PSYCHLOPS). Intention-to-treat (ITT) analyses showed significant but small effects of condition on psychological distress (mean difference: -0.15; 95% CI: -0.28, -0.02; p = .02) and functioning (mean difference: -2.04; 95% CI: -3.87, -0.22; p = .02) at 3-month follow-up. There were no significant differences between groups on symptoms of PTSD and self-identified problems. Remission rates did not differ between conditions on any of the outcomes. COD was used by 9.4% of participants for a median of 1 contact per person. The main limitations are high intervention dropout and low utilization of COD support. Conclusions The trial provides a real-world implementation case, showing small positive effects of a digital, potentially scalable and self-guided mental health intervention for Syrian refugees in Egypt in reducing psychological distress and improving overall functioning. Further user-centered adaptations are required to improve adherence and effectiveness while maintaining scalability. Trial registration German Register for Clinical Studies DRKS00023505., Author(s): Sebastian Burchert 1,*, Mhd Salem Alkneme 1, Ammar Alsaod 1, Pim Cuijpers 2,3, Eva Heim 4, Jonas Hessling 1, Nadine Hosny 4,5, Marit Sijbrandij 2, Edith van't Hof 6, [...]

Culturally sensitive behavioral health services are scarce, particularly in rural and underserved areas. To expand integrated behavioral health care training for providers, specifically those working in rural communities and federally qualified health centers, an interprofessional teleconsultation program was developed. Given the desire to focus on culturally informed care training, this was done in partnership with a nonprofit community mental health agency which focuses on behavioral health within Latinx populations. The teleconsultation sessions were provided bimonthly using Zoom and included didactic components and case-based discussion using the Multidimensional Ecosystemic Comparative Approach (MECA; Falicov, 1995; Falicov, 2017). Participants represented a diverse, interprofessional group composed of behavioral health professionals (45.2%), primary care physicians (26.8%), family medicine residents (15.3%), and others (medical students and administrative staff [12.7%]). The program evaluation demonstrates that participants valued the teleconsultation sessions and articulated specific skills that they subsequently planned to integrate into their clinical practice to enhance care. This teleconsultation model allows interprofessional training across multiple types of organizations to enhance knowledge in providing integrated behavioral health care for Latinx populations. Keywords: behavioral health, interprofessional, teleconsultation, Latinx, The United States is facing a crisis regarding behavioral health delivery which is both equitable and inclusive to the diverse geographic and cultural makeup of US residents. Almost half of [...]

Purpose The interplay between critical illness and mental disorders is poorly understood. The purpose of this study is to measure both the treated prevalence of mental disorders and psychotropic medication use before and after hospitalization and the impact of intensive care unit (ICU) admission on these outcomes. Methods Using a population-based administrative database in Manitoba, Canada, 49,439 ICU patients admitted between 2000 and 2012 were compared to two matched comparison groups (hospitalized; n = 146,968 and general population; n = 141,937). Treated prevalence of mental disorders and psychotropic medication prescriptions were measured in the 5-year periods before and after the hospitalization. Multivariable models compared adjusted prevalence ratios (APRs) between populations. Results The 5-year treated mental disorder prevalence in the ICU population increased from 41.5% pre-hospitalization to 55.6% post-hospitalization. Compared to non-ICU hospitalized patients, the adjusted treated mental disorder prevalence in ICU patients was lower prior to hospitalization (1-year APR 0.94, 95% CI 0.92-0.97, p < 0.0001; 5-year APR 0.99, 95% CI 0.98-1.00, p = 0.1), but higher following discharge (1-year APR 1.08, 95% CI 1.05-1.11, p < 0.0001, 5-year APR 1.03, 95% CI 1.01-1.05, p < 0.0001). A high proportion of ICU patients received antidepressant, anxiolytic and sedative-hypnotic prescriptions before and after their hospitalization. In multivariable analyses, ICU exposure was associated with an increase in mood, anxiety and psychotic disorders, and sedative-hypnotics use (p < 0.0001 for all Time x Group interactions). Conclusions During the 5 years after admission to ICU, there is a significant increase in treated prevalence of mental disorders and psychotropic medication use compared to the 5 years prior to ICU and compared to general population and hospital cohorts. Prevention and intervention programs that identify and treat mental disorders among survivors of critical illness warrant further study., Author(s): Kendiss Olafson [sup.1], Ruth Ann Marrie [sup.1] [sup.2], James M. Bolton [sup.2] [sup.3] [sup.4], Charles N. Bernstein [sup.1], O. Joseph Bienvenu [sup.5], Maia S. Kredentser [sup.6], Sarvesh Logsetty [sup.3] [...]

Problem Mental ill health in the United Kingdom of Great Britain and Northern Ireland has been a major driver of labour market exclusion through sickness absence, reduced productivity and job loss. Approach A government-supported programme for improving access to psychological therapies was launched in 2008 and expanded across England in 2010. The aim was to provide evidence-based treatments for people with common mental disorders through three principal strategies: (i) routine session-by-session outcome monitoring; (ii) integration with the wider care system; and (iii) delivery of psychological therapies as part of a stepped-care approach. Local setting Access to effective psychological therapies was previously low in the United Kingdom. In 2010, only about 35% of people with moderately severe mental disorders were in specialist or non-specialist treatment. Relevant changes The accessibility of quality mental health services has increased, as has the efficiency of the country's mental health system. The numbers of people entering treatment have increased steadily from 0.43 million in 2012-2013 to 1.09 million in 2018-2019. The recovery rate of patients in treatment increased from 42.8% to 52.1% during 2012-2018. The number of people moved off sick pay and benefits rose from 3683 to 18 039 over the same period. Lessons learnt A clinical guideline on psychological therapies is a prerequisite for increasing the accessibility and efficiency of mental health services. An integrated approach allows mental health services to have better reach. Routine collection of patient-level outcome data plays an important role in the value and function of the mental health care system. Probleme La maladie mentale au Royaume-Uni de Grande-Bretagne et d'Irlande du Nord a ete l'un des principaux facteurs d'exclusion du marche du travail a cause de l'absenteisme pour raisons de sante, de la baisse de productivite et de la perte d'emploi. Approche Un programme d'amelioration de l'acces aux therapies psychologiques, soutenu par le gouvernement, a ete lance en 2008 et s'est etendu a travers l'Angleterre en 2010. Le but etait de proposer des traitements reposant sur des donnees factuelles aux personnes presentant des troubles mentaux courants, grAce a trois strategies majeures: (i) un suivi des resultats au fil des seances; (ii) une integration au sein du systeme de soins global; et, enfin, (iii) la mise en place de therapies psychologiques dans le cadre d'une approche par paliers. Environnement local Lacces a des therapies psychologiques efficaces etait auparavant difficile au Royaume-Uni. En 2010, seulement 35% des gens souffrant de troubles mentaux relativement graves suivaient un traitement specialise ou non specialise. Changements significatifs Laccessibilite a des soins de sante mentale de qualite s'est amelioree, tout comme l'efficacite du systeme de sante mentale du pays. Le nombre d'individus ayant entame un traitement a augmente de facon constante, evoluant de 0,43 million en 2012-2013 a 1,09 million en 2018-2019. Le pourcentage de guerison des patients traites a grimpe de 42,8% a 52,1% entre 2012 et 2018. En outre, le nombre de personnes ayant mis fin a leurs prestations ou indemnites de maladie est passe de 3680 a 18 039 sur la meme periode. Lecons tirees Une directive clinique relative aux therapies psychologiques est l'une des conditions prealables necessaires au developpement de l'accessibilite et de l'efficacite des soins de sante mentale. Une approche integree permet aux services de sante mentale de toucher un plus large public. La collecte systematique des donnees sur les resultats observes chez les patients joue un role crucial dans la qualite et le fonctionnement du systeme de soins de sante mentale. Situacion En Gran Bretana e Irlanda del Norte, las enfermedades mentales han sido uno de los principales motores de la exclusion del mercado laboral a traves de las bajas por enfermedad, la reduccion de la productividad y la perdida de empleo. Enfoque En 2008 se puso en marcha un programa apoyado por el gobierno para mejorar el acceso a las terapias psicologicas, que se amplio a toda Inglaterra en 2010. El objetivo era proporcionar tratamientos basados en la evidencia para personas con trastornos mentales comunes a traves de tres estrategias principales: (i) seguimiento rutinario de los resultados sesion tras sesion; (ii) integracion con el sistema de atencion mas amplio; y (iii) prestacion de terapias psicologicas como parte de un enfoque de atencion escalonada. Marco regional Antes, el acceso a terapias psicologicas eficaces era escaso en el Reino Unido. En 2010, solo un 35% de las personas con trastornos mentales moderadamente graves recibian tratamiento especializado o no especializado. Cambios importantes El acceso a los servicios de salud mental de calidad ha aumentado, al igual que la eficiencia del sistema de salud mental del pais. Las cifras de personas que entran en tratamiento han aumentado de forma constante, pasando de 0,43 millones en 2012-2013 a 1,09 millones en 2018-2019. La tasa de recuperacion de los pacientes en tratamiento aumento del 42,8% al 52,1% durante 2012-2018. El numero de personas que dejaron de recibir pagas por enfermedad y prestaciones aumento de 3.680 a 18. 039 durante el mismo periodo. Lecciones aprendidas Una guia clinica sobre terapias psicologicas es un requisito previo para aumentar la accesibilidad y la eficacia de los servicios de salud mental. Un enfoque integrado permite que los servicios de salud mental tengan un mejor alcance. La recogida rutinaria de datos de resultados a nivel de paciente desempena un papel importante en el valor y la funcion del sistema de atencion a la salud mental., Introduction The burden of mental disorders is rising worldwide. Around one in six people suffer from mental disorders, with the highest prevalences in North America, Western Europe, North Africa, the [...]