Depression screening and treatment among uninsured populations in Primary Care

Uninsured populations have poor treatment engagement and are less likely to receive evidence-based interventions for depression. The objective of the current study was to retrospectively examine depression screening, diagnosis, and treatment patterns among uninsured patients in primary care. Study sample included all patients (N = 11,803) seen in nine community-based clinics. Key variables included depression screener and/or a depression diagnosis, anti-depressant initiation, behavioral health visits, and patient follow up measures. Treatment patterns from the subsample of patients diagnosed with depression were analyzed by collecting the number of behavioral health visits and antidepressant use six months (180 days) following the diagnosis. Utilization of the depression screening tool was high (67%, n = 7,935) and 24% (n = 2,789) of the patients had a diagnosis of depression, however, more than half of the patients with a depression diagnosis did not have a recorded treatment plan (n = 1,474). The odds of anti-depressant use and behavioral visits for Hispanic patients were significantly greater than for Non-Hispanic patients. Universal screening with brief measures in primary care is improving, however, guideline-concordant depression treatment remains elusive for uninsured populations.     

Citizen Advocacy Observed: Tool or Tokenism?

Citizen advocacy, where a volunteer works in partnership with a vulnerable person, compliments self- and legal advocacy. In the context of mental health services, citizen advocacy is a tool for enabling and empowering people who use these services, and is founded on the recognition that mental health service users are frequently socially oppressed and disadvantaged. This article describes the development of a Citizen Advocacy service for people with mental health difficulties, and also the problems they brought to this service. The problems encountered in sustaining the service are noted and lessons are drawn for the future.     

Engagement and Interaction: A Comparison Between Supported Employment and ATCs

The interaction and engagement patterns of 13 supported employees and 38 regular Adult Training Centre (ATC) attenders were compared. Data were obtained through direct observation within 13 employment sites and a representative sample of ATC organised activities. Results indicated that individual involvement was significantly higher in employment, compared to ATCs, but that the ATC group experienced significantly more social interaction, mainly due to higher levels of task specific dialogue between individuals and the service staff within ATCs. A breakdown of with whom interactions occurred revealed that individuals in ATCs tended to interact more often with care staff than anyone else. Individuals tended to interact more often during work with their non-disabled co-workers and a substantial proportion of time was spent interacting with the public. These findings suggest that the supported employment option yields advantages for individuals in some key aspects of community integration, compared to ATCs.     

Training Counsellors to Work with People who Live with Cancer: A Needs-led Approach to Planning

This paper traces the development of a cancer counselling service within a voluntary helping agency. The steps of recognizing the needs of people with cancer, identifying multi-faceted desired outcomes and the implementation of one specific goal, that of provision of a counselling service, are outlined. Significant events, stages and decisions made during this process are described and discussed. The emphasis throughout is on the importance of needs analysis and client group consultation in order that the planned service is best placed to meet such needs.     

Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya

Youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed and evaluated such an intervention, targeting adolescent depression and anxiety in Kenya, where mental health care is limited by social stigma and a paucity of providers. Kenyan adolescents (N = 51, ages 14–17, 60.78% female) from a school in an urban slum in Nairobi with self-reported moderate-to-severe symptoms of depression or anxiety were randomized to the 4-week “Shamiri” (“thrive”) group intervention or a study skills control intervention of equal duration. The Shamiri intervention included growth mindset, gratitude, and value affirmation exercises. The content was delivered by recent high school graduates (ages 17–21, 60% male) trained as lay-providers. Participants met in school once-a-week in groups of 9–12 youths (average group size 10). Compared to the study-skills control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to 4-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p = .028, d = .71). This appears to be the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. Larger replications with extended follow-ups will help gauge the strength and durability of these effects.     

Relationships Among Emerging Adult Psychological Problems,Maltreatment, and Parental Psychopathology: Moderation by Parent–Child Relationship Quality

Current research supports clear relationships between parental psychopathology, parental maltreatment, and emerging adult child psychopathology. Less research has examined how the role of the parent–child relationship influences these existing associations. The current study tested two models that examined the moderating effect of parent–child relationship quality on parental psychopathology and emerging adult mental health as well as the effect on parental maltreatment and emerging adult mental health. It was expected that high parent–child relationship quality would buffer against the negative effects of parental psychopathology and maltreatment while enhancing the effects of functional parenting characteristics. Participants included 1,452 emerging adults, predominantly Caucasian (73.3%) college students who completed surveys on their mental health, recent experienced maltreatment, and their parents’ mental health problems. Results suggested lowest rates of mental health problems for emerging adults were associated with higher parent–child relationship quality and lower parental psychological problems, whereas negative outcomes were associated with higher parental psychopathology, regardless of parent–child relationship quality. Additionally, physical maltreatment was associated with lower rates of mental health concerns in the context of higher mother-daughter relationship quality. Results emphasize the continuing impact of the parent–child relationship, particularly the mother-daughter relationship, on emerging adults’ mental health. Moreover, the current study demonstrates the continuing influence of parents on their emerging adult children.     

The Performance Diagnostic Checklist-Human Services: A brief review

The Performance Diagnostic Checklist-Human Services (PDC-HS) is an informant-based tool designed to identify the variables contributing to poor employee performance in human service settings, such as clinics, schools, and residential facilities. Upon completion of the tool, an intervention indicated by PDC-HS results is used to improve employee performance. To date, the PDC-HS has been used in a number of studies. This review describes the existing research on the PDC-HS and provides suggestions for future research.     

Continuum between Relational and Therapeutic Models of Self-help in Mental Health: A Qualitative Approach

Self-help groups are generally described as “group[s] composed of individuals who meet on a regular basis to help one another cope with a life problem” (APA, 2019). Yet, it is challenging to find a univocal definition of self-help groups. Scholars usually use different labels to highlight various features of self-help groups, suggesting the need for further inquiry regarding commonalities and differences. The level of professional involvement is one of the most disputed factors influencing whether a group is considered to belong to the “self-help family.” The present qualitative study aimed to understand how professional support in Tuscany, Italy can influence the organizational choices of these groups (place for meetings, admission criteria, timing, etc.), as well as the personal beliefs of members. The study included 17 self-help groups. During 13 focus groups meetings, 92 participants were interviewed; then, we individually interviewed 19 facilitators and six additional key informants from mental health settings. We used a grounded theory approach, and we discussed the emerging models with participants at a public event. Results show the emergence of two theoretical models to define self-help groups, not to be interpreted as mutually exclusive. The “relational model” refers to self-help groups whose main feature is to guarantee the acquisition of specific skills (social comparison skills, active listening, and empathy), while the “therapeutic model” seems to represent a kind of assimilation of other types of interventions.