The Mental Health Minute

Articles and news about mental health issues

Global Study Tracks Pediatric Mental Illness Incidence, Treatment

The Lancet

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Here is an article from Clinical Psychiatry News  showing that mental illness is a global concern and we, as a people, are doing miserably at attending to the needs of this population globally.  Children, especially, are vulnerable to in-utero exposure to toxins, and can end up with mental illness from that exposure.

Environmental toxins, major health outbreaks, poor nutrition all contribute to the number of mentally ill people across the globe.  But this article goes on to say that there are interventions that are effective if put in place early enough, but because some country is poor or moderately poor, they have no funds to implement these easy fixes.  Their citizens then are left unprotected and untreated, for the most part.

This article is an attempt to show that we are neglecting the needs of the mentally ill at an alarming rate.  Please go to the original site and read not only this article, but others similar to educate and enlighten yourself on the plight of the mentally ill globally.

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By: JENNIE SMITH, Clinical Psychiatry News Digital Network

 

Up to one in five children and adolescents worldwide has a mental health disorder, according to a broad-ranging new study, yet mental health interventions, and the research to support them, are neglected in low- and middle-income countries.

While 90% of the world’s 2.2 billion children and adolescents live in low- and middle-income countries, researchers found, only 10% of mental health trials for this population are conducted in these countries.

A dearth of research expertise in low- and middle-income countries is one contributing factor, said Atif Rahman, Ph.D., of the University of Liverpool and Alder Hey Children’s NHS Foundation Trust, in Liverpool, U.K., the corresponding author of the study.

“In most developing countries, the universities are not really geared up for research,” Dr. Rahman said in an interview. “If there’s not enough research infrastructure and no career structure for researchers, it’s not really going to be possible to do the research on the types of psychological and psychosocial interventions that work in these countries,” he said. And less than a third of low- and middle-income countries have a national policy that deals with mental health among children and adolescents.

The findings were published Oct 17 in the Lancet ([2011 [doi:10.1016/S0140-6736[11]60827-1]) as part of a global mental health series that explored disparities in mental health prevention and treatment worldwide.

Another article in the series (Lancet 2011 [doi:10.1016/S0140-6736[11]61093-3]) found that trained mental health clinicians can be surprisingly scarce in developing countries, because of emigration: Sri Lanka, for example, had only 25 psychiatrists living there in 2007, while 142 who trained there had emigrated. A third paper, led by another group of international researchers (Lancet 2011 [doi:10.1016/S0140- 6736[11]60891-X]), found that children were not alone in getting inadequate mental health attention – that while 1 in 3 people with a mental health problem in wealthy nations receives treatment, in developing countries, it can be as few as 1 in 50.

For their research, Dr. Rahman and his colleagues analyzed epidemiologic studies to determine the prevalence of child and adolescent mental health problems in low- and middle-income countries. They also looked at randomized controlled trials evaluating preventative and treatment strategies.

They identified a number of effective interventions – particularly school- and community-based programs, in such diverse countries as China, Mauritius, and Iran – that were shown to successfully address behavioral problems, drug use initiation, and anxiety.

Maternal and child nutritional supplementation, immunization programs, reduction of exposure to toxins, maternal health interventions, malaria prevention, and early stimulation programs were all found to prevent cognitive deficits in low- and middle-income countries.

While there are a number of trials for preventative interventions in low- and middle-income countries, “There are only a handful of treatment trials,” Dr. Rahman said. Of the more than 670 treatment trials the investigators identified for the study, 58 came from middle-income countries and only 1 was from a low-income country.

The researchers decided to include in their analysis some treatment trials done in low-income populations in higher-income countries, such as those enrolling African-American children in the United States, noting that many mental health risk factors for children and adolescents were found to be similar across higher- and lower-income countries.

But Dr. Rahman noted that interventions developed in the West might not be feasible in lower-income settings where, for example, mental health specialists may be few and far between.

“Mental health problems in children in high- and low-income countries may share similar risk factors, especially in poor and disadvantaged communities. How you treat them will be very different depending on the health, social, and community-based systems available. There is the issue of who is there to deliver them – in a low-income setting you might have to adapt your interventions or develop new ones so that nonspecialists can deliver them,” he said.

“This is why the 90-10 research gap is so important,” Dr. Rahman continued. “You can’t just implement a strategy developed in the West. You have to find the right one, which is culturally appropriate and feasible, and requires research, trials, and cost-effectiveness analyses.”

In addition to calling for more randomized controlled trials, Dr. Rahman and his colleagues made several recommendations, based on their findings, for child and adolescent mental health programming in low- and middle-income countries.

Integration with existing, community-based systems is feasible, they wrote.

Early interventions and rehabilitative or curative interventions “need to develop side by side, which can be made efficient by task sharing,” they wrote, and advised partnering with physical health programs and agencies outside the health sector – in education, social care, and criminal justice. And finally, they wrote, “awareness programs and mobilization of potential stakeholders should be considered as part of any child and adolescent mental health service development.”

The researchers noted as a limitation of their study a heterogeneity in the prevalence studies that prevented either direct comparisons between countries or meta-analytic approaches. Two of Dr. Rahman’s coauthors reported disclosures: Dr. Christian Kieling took part in meetings sponsored by Novartis, Shire, and Deva. Dr. Luis Augusto Rohde acted as speaker or consultant for Eli Lilly, Janssen-Cilag, Novartis, and Shire, and received program funding and research support from those companies.

There was no external funding, and each of the researchers contributed their time to the study.

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October 17, 2011 - Posted by | Mental Health | , , , , ,

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