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1.  Comprehensive SDG goal and targets for non-communicable diseases and mental health 
The negotiations on the SDG goals and targets, leading to the sustainable development Declaration in September 2015, are now in the final stages. Ensuring that people with mental disorders are not left behind in the global development program from 2015 to 2030 will require specific and explicit commitments and targets against which progress in mental health can be measured and reported. The arguments for inclusion of explicit mental health targets in the SDGs are compelling. The final negotiations on the SDG goals and targets will now determine whether people with mental illness and psychosocial disabilities will continue to be neglected or will benefit equitably from inclusion in the post-2015 development program.
doi:10.1186/s13033-015-0003-0
PMCID: PMC4359436  PMID: 25774216
Development; Sustainable development goals (SDG)
2.  A qualitative exploration of the perspectives of mental health professionals on stigma and discrimination of mental illness in Malaysia 
Background
Stigma of mental illness has been identified as a significant barrier to help-seeking and care. Basic knowledge of mental illness - such as its nature, symptoms and impact - are neglected, leaving room for misunderstandings on mental health and ‘stigma’. Numerous researches have been conducted on stigma and discrimination of people with mental disorders. However, most of the literature investigates stigma from a cultural conception point of view, experiences of patients or public attitudes towards mental illness but little to none from the standpoint of mental health professionals. In Malaysia, this research on stigma is particularly limited. Therefore, the state of stigma and discrimination of people with mental illness was investigated from the perspectives of mental health professionals in Malaysia.
Methods
In-depth, face-to-face, semi-structured interviews were conducted with 15 mental health professionals from both government and private sectors including psychiatrists, psychologists and counsellors. The interviews were approximately 45-minutes long. The data was subsequently analysed using the basic thematic approach.
Results
Seven principal themes, each with their own sub-themes, emerged from the analysis of ‘stigma of mental illness’ from mental health professionals’ point of view, including: (1) main perpetrators, (2) types of mental illness carrying stigma, (3) demography and geography of stigma, (4) manifestations of stigma, (5) impacts of stigma, (6) causes of stigma and (7) proposed initiatives to tackle stigma. Stigma of mental illness is widespread in Malaysia. This is most evident amongst people suffering from conditions such as schizophrenia, bipolar disorder and depression. Stigma manifests itself most often in forms of labelling, rejection, social exclusion and in employment. Family, friends and workplace staff are reported to be the main perpetrators of discriminatory conducts.
Conclusion
According to the perspectives of the mental health professionals, implications of stigma include patients being trapped in a vicious cycle of discrimination leading to detrimental consequences for the individual, their families, communities and society as a whole. There is a pressing need to address stigma of mental illness and its consequences, especially through raising awareness of mental health and wellbeing in Malaysia, as reported by the mental health professionals.
doi:10.1186/s13033-015-0002-1
PMCID: PMC4359579  PMID: 25774215
Mental health; Malaysia; Mental health Malaysia; Mental health professionals; Mental illness; Stigma; Discrimination
3.  Length of stay of psychiatric admissions in a general hospital in Ethiopia: a retrospective study 
Background
In sub-Saharan Africa, the number of psychiatric beds per population is disproportionately low. Moreover, there is a lack of data regarding the patterns of psychiatric admissions and the factors leading to long psychiatric hospitalization in this region. This study aimed to investigate the average length of stay (LOS) and the factors associated with prolonged hospitalizations.
Methods
A ten-year retrospective chart review of patients admitted to the psychiatric facility of Jimma University Specialized Hospital in southwest Ethiopia was conducted. The medical charts of 846 admissions spanning the period from January 2001 to December 2010 were reviewed. LOS greater than 21 days was considered as a cut-off point for lengthier stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors independently associated with LOS.
Results
The most common discharge diagnoses were schizophrenia and other psychotic disorders (27.6%), and bipolar disorder (23.4%). A global clinical rating taken on discharge showed 90.3% improved outcome. The median (25th, 75th percentiles) LOS was 22 (15, 36) days. Patients with major depressive disorder [aOR = 0.51 (0.32 – 0.81)] and brief psychotic disorder [aOR = 0.52 (0.33 – 0.84)] were less likely than patients with schizophrenia and other psychotic disorders to have long hospital stays. Presence of extrapyramidal side-effects and out of pocket expenditures predicted LOS.
Conclusions
Patients with psychoses and bipolar disorder have lengthier hospital stays burdening the cost of care of psychiatric treatment in a general hospital setting. Our findings call for identifying those cases quickly, attending to their needs with evidence-based efficient treatment and for improving and developing an aftercare system such that the utilization of acute inpatient beds, already a scarce resource, could achieve higher efficiency.
doi:10.1186/s13033-015-0006-x
PMCID: PMC4361196  PMID: 25780386
Psychiatric admission; Mental illness; Psychiatric care; Length of hospital stay; Sub-Saharan Africa; Ethiopia
4.  Self-care strategies for emotional distress among young adults in Catalonia: a qualitative study 
Background
Emotional distress is common in adolescence, and self-care strategies are frequently preferred to address it. The aim of this article is to analyze the self-care strategies among adolescents and young people diagnosed with depression or with self-perceived depressive distress in Catalonia using a qualitative design.
Methods
We analyzed the self-care strategies of 105 young people (17–21 years of age) in Catalonia who had participated in a national survey on adolescents. The sample was divided into thirds, with 37 who had a previous diagnosis of depression, 33 who had self-perceived emotional distress, and 35 controls. The participants’ narratives on self-care strategies for emotional distress were elicited through in-depth semi-structured interviews. The data were managed using ATLAS-Ti 6.5 software18. We applied hermeneutic theory and the ethnographic method to analyze the interviews.
Results
The ten self-care strategies identified in the analysis were grouped into four areas covering the various pathways the young people followed according to whether they had a diagnosis of depression or their depressive distress was self-perceived. The young people feel responsible for their emotional distress and consider that they are capable of resolving it through their own resources. Their strategies ranged from their individuality to sociability expressed through their relationships with others, membership of groups or other self-care strategies (relaxation, meditation, naturopathy, etc.).
Conclusions
The study results highlight the importance of sensitivity in considering young people’s self-care strategies as another option in the care of emotional distress.
Electronic supplementary material
The online version of this article (doi:10.1186/s13033-015-0001-2) contains supplementary material, which is available to authorized users.
doi:10.1186/s13033-015-0001-2
PMCID: PMC4363191  PMID: 25788975
Adolescents; Mental health and illness; Self-care; Self-help; Social support; Young adults
5.  Knowledge transfer in the field of parental mental illness: objectives, effective strategies, indicators of success, and sustainability 
Background
Mental health problems are often transmitted from one generation to the next. However, transferring knowledge about interventions that reduce intergenerational transmission of disease to the field of parental mental illness has been very difficult. One of the most critical issues in mental health services research is the gap between what is generally known about effective treatment and what is provided to consumers in routine care.
Discussion
In this article we discuss several aspects of knowledge transfer in the field of parental mental illness. Effective strategies and implementation prerequisites are explored, and we also discuss indicators of success and sustainability.
Summary
Altogether, this article presents a rationale for the importance of preventive strategies for children of mentally ill parents. Furthermore, the discussion shows how complex it is to change clinical practice.
doi:10.1186/1752-4458-9-6
PMCID: PMC4327801  PMID: 25685185
Health system improvement; Children of mentally ill parents; Effective strategies; Sustainability
6.  Defining outcome measures of hospitalization for assessment in the Japanese forensic mental health scheme: a Delphi study 
Background
A new legislation concerning forensic mental health was established by the Japanese Government in 2005, the “Act on Medical Care and Treatment for the Persons Who Had Caused Serious Cases under the Condition of Insanity,” or the Medical Treatment and Supervision (MTS) Act. Since it was passed, however, there has been broad controversy over Hospitalization for Assessment (HfA), the first stage of the MTS scheme.
Methods
Following a comprehensive literature search to assemble a list of candidates, we conducted a Delphi study to establish standard outcome measures for HfA.
Results
Five Delphi rounds were conducted by 19 panelists including medical practitioners and lawyers. A total of 139 items were accepted as outcome measures for HfA based on panel agreement.
Conclusion
The Delphi study established a list of HfA outcome measures for the MTS act, which will contribute to the optimization of the new forensic mental health system in Japan.
Electronic supplementary material
The online version of this article (doi:10.1186/1752-4458-9-7) contains supplementary material, which is available to authorized users.
doi:10.1186/1752-4458-9-7
PMCID: PMC4328080  PMID: 25685186
Forensic mental health; Delphi study; the Medical Treatment and Supervision Act; Hospitalization for Assessment; Outcome measure
7.  Psychosocial correlates of using faith healing services in Riyadh, Saudi Arabia: a comparative cross-sectional study 
Background
In this study, we compared the prevalence of psychiatric disorders and the characteristics of those who either use or do not use faith healers (FHs) services. We also assessed the independent factors of study subjects associated with using FHs.
Methods
This cross-sectional study compared those who use FHs (n = 383) with a control group of those who do not use them (i.e., shopping mall visitors, n = 424) using a survey of sociodemographic characteristics and a validated Arabic version of the Mini International Neuropsychiatric Interview (MINI 6.0).
Results
Participants who ranked higher among FH users included males, people who were either married, divorced, or widowed, those with less education, and those with lower income. They were more likely to report past medical and psychiatric history. Those with diagnosable psychiatric disorders were more likely to visit FHs, especially if the diagnosis was of psychotic and bipolar disorders. The prevalence of psychiatric disorders was higher among FH users, and depressive and anxiety disorders were the most prevalent.
Conclusions
The study showed that having past psychiatric history and a current psychiatric disorder are risk factors for using FHs. Also, a high percentage of FH users had a diagnosable psychiatric disorder. Further research should assess how to facilitate their access to the mental health system.
doi:10.1186/1752-4458-9-8
PMCID: PMC4328536  PMID: 25685187
Faith healing; Psychosocial correlates; Prevalence; Psychiatric disorders; Saudi Arabia
8.  An overview of the mental health system in Gaza: an assessment using the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) 
Background
Mental health system reform is urgently needed in Gaza to respond to increasing mental health consequences of conflict. Evidence from mental health systems research is needed to inform decision-making. We aimed to provide new knowledge on current mental health policy and legislation, and services and resource use, in Gaza to identify quality gaps and areas for urgent intervention.
Methods
As part of a mixed methods study, we used the World Health Organization’s Assessment Instrument for Mental Health Systems Version 2·2 to collect data on mental health services and resources. Data collection was carried out in 2011, based on the year 2010.
Results
Gaza’s mental health policy suggests some positive steps toward reform such as supporting deinstitutionalisation of mental health services. The decrease in the number of beds in the psychiatric hospital and the progressive transition of mental healthcare toward more community based care are indicative of deinstitutionalisation. However, mental health legislation in support of deinstitutionalisation in Gaza is lacking. The integration of mental health into primary healthcare and general hospitals has not been fully achieved. Mental health in Gaza is underfunded, human rights protection of service users is absent, and human resources, service user advocacy, and mental health training are limited.
Conclusion
Priority needs to be given to human rights protection, mental health training, and investment in human and organisational resources. Legislation is needed to support policy and plan development. The ongoing political conflict and expected increase in need for mental health services demonstrates an urgent response is necessary.
doi:10.1186/1752-4458-9-4
PMCID: PMC4361134  PMID: 25780385
Mental health systems; Mental health; Global mental health; Policy; Legislation; WHO-AIMS; Gaza
9.  Existing public health surveillance systems for mental health in China 
Mental health is a challenging public health issue worldwide and surveillance is crucial for it. However, mental health surveillance has not been developed until recently in certain developed countries; many other countries, especially developing countries, have poor or even no health information systems. This paper presents surveillance related to mental health in China, a developing country with a large population of patients with mental disorders. Detailed information of seven relevant surveillance systems is introduced respectively. From the perspective of utilization, problems including accessibility, comprehensiveness and data quality are discussed. Suggestions for future development are proposed.
doi:10.1186/1752-4458-9-3
PMCID: PMC4298056  PMID: 25601892
Public health surveillance; Mental health; China; Review
10.  Correlates of psychological functioning of homeless youth in Accra, Ghana: a cross-sectional study 
Background
Research on homeless youth has shown that this population is at high risk for various mental health problems. Previous studies conducted among homeless young adults in Ghana have focused primarily on economic, social and cultural causes of homelessness, their engagement in risky sexual behaviours and the prevalence of STI including HIV/AIDS. We are therefore not fully informed of the prevalence of psychological symptoms and their associated factors. The aim of the study was to determine the association between psychological functioning and social and health risk behaviours among a sample of homeless youth in Ghana.
Methods
A cross-sectional survey of a convenience sample of 227 (122 male and 105 female) homeless youth was conducted in Ghana in 2013. An interviewer-administered questionnaire was used to collect data due to low level of literacy among the study population. Pearson-moment correlation coefficient (r) and multiple standard regression models were fitted to analyse the data.
Results
Approximately 87% of the participants in this study exhibited moderate to severe psychosocial symptoms. Specifically, emotional, conduct, hyperactivity and peer relationship problems among the participants were 69%, 74%, 54% and 89% respectively. Overall psychosocial functioning was predicted by stigma (self-stigma and experienced stigma), violent behaviours and suicidal ideation. Substance use and perceived resilience were significantly associated with emotional problems.
Conclusion
There is a need for holistic interventions to help improve the psychological and social functioning of homeless youth. Such programmes should strengthen socio-emotional coping strategies in street youth as well as address contextual risk factors such as stigma and discrimination by the public.
doi:10.1186/1752-4458-9-1
PMCID: PMC4292989  PMID: 25587353
Homeless youth; Mental health; Psychological functioning; Resilience; Substance use; Violent behaviours
11.  Social network analysis of international scientific collaboration on psychiatry research 
Background
Mental disorder is harmful to human health, effects social life seriously and still brings a heavy burden for countries all over the world. Scientific collaboration has become the indispensable choice for progress in the field of biomedicine. However, there have been few scientific publications on scientific collaboration in psychiatry research so far. The aim of this study was to measure the activities of scientific collaboration in psychiatry research at the level of authors, institutions and countries.
Methods
We retrieved 36557 papers about psychiatry from Science Ciation Index Expanded (SCI-Expanded) in web of science. Additionally, some methods such as social network analysis (SNA), K-plex analysis and Core-Periphery were used in this study.
Results
Collaboration has been increasing at the level of authors, institutions and countries in psychiatry in the last ten years. We selected the top 100 prolific authors, institutions and 30 countries to construct collaborative map respectively. Freedman, R and Seidman, LJ were the central authors, Harvard university was the central institution and the USA was the central country of the whole network. Notably, the rate of economic development of countries affected collaborative behavior.
Conclusion
The results show that we should encourage multiple collaboration types in psychiatry research as they not only help researchers to master the current research hotspots but also provide scientific basis for clinical research on psychiatry and suggest policies to promote the development of this area.
doi:10.1186/1752-4458-9-2
PMCID: PMC4297364  PMID: 25598839
Psychiatry; Collaboration; SNA
12.  “Walking alongside:” collaborative practices in mental health and substance use care 
Background
Although the importance of collaboration is well established as a principle in research and in theory, what it actually means for practitioners to collaborate in practice, to be partners in a collaborative relationship, has thus far been given less attention. The aim of this study was to identify key characteristics of the ways in which mental health practitioners collaborate with service users and their families in practice.
Methods
This was a qualitative action research study, with a cooperative inquiry approach that used multi-staged focus group discussions with ten mental health care and social work practitioners in community mental health and substance use care. Thematic analysis was applied to identify common characteristics.
Results
We identified three major themes related to practitioners’ experiences of collaborative practices: (1) walking alongside through negotiated dialogues, (2) maintaining human relationships, and (3) maneuvering relationships and services.
Conclusions
It appears that even with the rich knowledgebase that has developed on the merits of collaborative relationships, it continues to be challenging for practitioners to reorient their practice accordingly. The findings of this study indicate that the practitioners focus on two types of processes as characterizing collaborative practice: one focusing on conversations among practitioners and service users and their families and the other focusing on management and control among health care providers, service sectors, and service users (i.e., inter/intra-system collaboration).
doi:10.1186/1752-4458-8-55
PMCID: PMC4276107  PMID: 25540670
Community mental health care; Collaborative practices; Co-occurring mental health and substance use problems; Recovery; Shared decision-making; Action Research; Cooperative Inquiry
13.  Difference in suicide methods used between suicide attempters and suicide completers 
Background
In light of the increased suicide rate in Korea, it has become important for researchers to examine the various factors associated with it. The purpose of this study is to compare and analyze the difference between suicide attempters and completers in terms of the suicide methods used and the lethality of these methods. In addition, we investigated certain demographic factors that are associated with the choice of suicide method by evaluating their lethality.
Finding
The most frequently used methods of suicide were different in the two groups of attempters and completers. Drug poisoning was the most frequent method in suicide attempters, whereas hanging was the most common method among suicide completers. Drug poisoning, stabbing, and other chemical poisoning were evaluated as relatively non-lethal compared to other suicide methods. While about 70.0% of the suicide attempters used relatively non-lethal methods, almost all suicide completers used lethal methods, based on our classification of the lethality of the method. In terms of gender, males used more lethal methods of suicide.
Conclusions
Suicide completers’ choice of suicide methods are different from those of suicide attempters and tend to be more lethal. Interventions to restrict access to more lethal suicidal methods could be a useful strategy to reduce the suicide rates in South Korea.
doi:10.1186/1752-4458-8-54
PMCID: PMC4290454  PMID: 25584067
Suicide; Suicide method; Lethality; Suicide attempters; Suicide completers
14.  Power distance and mentor-protégé relationship quality as moderators of the relationship between informal mentoring and burnout: evidence from China 
Background
The topic of how to prevent and reduce burnout has drawn great attention from researchers and practitioners in recent years. However, we know little about how mentoring as a form of social support exerts influence on employee burnout.
Aim
This study aims to examine the contingency side of the mentoring-burnout relationship by addressing the exploratory question of whether individual differences in power distance and relationship quality play important roles in mentoring effectiveness in terms of reducing a protégé’s burnout level.
Methods
A total of 210 employees from a technology communications company completed the survey questionnaire.
Results
(1) A protégés’ power distance moderates the negative relationship between mentoring and burnout in such a way that the relationship is stronger for protégés who are lower rather than higher in power distance; (2) mentor-protégé relationship quality moderates the negative relationship between mentoring and burnout in such a way that the relationship is stronger when the relationship quality is higher rather than lower.
Conclusions
In sum, our results highlight the importance of studying the contingency side of mentoring effects on protégé burnout. Our findings suggest that the individuals’ different cultural values of power distance and mentor-protégé relationship quality are the boundary conditions for the mentoring-burnout relationship. We therefore suggest that research on mentoring-burnout will be advanced by considering the role of the moderating process.
doi:10.1186/1752-4458-8-51
PMCID: PMC4280691  PMID: 25553060
Burnout; Mentoring; Power distance; Mentor-protégé relationship quality
15.  Potential predictors of delay in initial treatment contact after the first onset of depression in Japan: a clinical sample study 
Background
A growing body of evidence shows that reducing the duration of untreated illness (DUI) correlates with improved clinical outcome and course of depression. However, the factors involved in delaying treatment contact after the first onset of lifetime depression are not fully understood. This cross-sectional study aims to identify the characteristics that may predict the delay in initial treatment contact after the first onset of lifetime depression by comparing the socio-demographics and clinical characteristics between those with longer and shorter DUI in a well-characterized Japanese clinical sample.
Methods
Ninety-five patients with depression with longer (>12 months) and shorter DUI (≤12 months) at three Japanese outpatient clinics were studied. Subjects received a comprehensive evaluation, including semi-structured clinical interviews and assessment battery, and their clinical charts were reviewed.
Results
Of the total sample, the median of DUI was 4 months (interquartile range (IQR) 25th–75th percentile, 2–13). We found that 72.6% of patients seek treatment contact within the first year of depression onset. Multivariate logistic regression analysis showed that longer DUI in patients was associated with marital status (never married). Further, the DSM-IV melancholic features approached significance.
Conclusions
Our findings suggest that most Japanese patients with depression are likely to seek treatment within 1 year of onset, and that marital status and melancholia may be potential predictors of the delay in the initial treatment contact after the first onset of lifetime depression.
doi:10.1186/1752-4458-8-50
PMCID: PMC4271502  PMID: 25530800
Duration of untreated illness; Help-seeking; Major depressive disorder; Marital status
16.  Mental health training program for community mental health staff in Guangzhou, China: effects on knowledge of mental illness and stigma 
Background
In order to reduce the huge treatment gap in mental health, WHO has called for integrating mental health into primary care. The purposes of this study are to provide a training course to improve the community mental health staff’s knowledge of mental health and reduce stigma related to mental illness, as well as to evaluate the impact of this training on knowledge and stigma.
Methods
The training intervention was a one day course for community mental health staff in Guangzhou, China. Evaluation questionnaires were given before and after the training session. Mental health knowledge was assessed using two vignettes. Stigma was evaluated by the Mental Illness: Clinicians’ Attitudes Scale (MICA) and the Reported and Intended Behavior Scale (RIBS).
Results
A total of 99 community mental health staff from eight regions in Guangzhou, China were recruited for the study. The training course did not lead to a significant improvement of participants’ levels of mental health knowledge. The mean score of MICA decreased from 47.92 ± 8.63 to 43.53 ± 9.61 after the training (t = 6.64, P < 0.001). As for the RIBS, the mean scores increased from (14.12 ± 3.90) to (15.38 ± 3.41) at post-test (t = -5.44, P < 0.001), indicating a significant improvement.
Conclusions
The results from this study show that the training course is an effective way to improve community mental health staff’s attitudes toward people with mental illness in the short term, as well as to lessen the social distance between staff and people with mental illness.
doi:10.1186/1752-4458-8-49
PMCID: PMC4268793  PMID: 25520750
Training course; Stigma; Community mental health staff
17.  Institutionalization of deinstitutionalization: a cross-national analysis of mental health system reform 
Background
Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments.
Methods
We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011.
Results
Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals.
Conclusions
It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons.
Electronic supplementary material
The online version of this article (doi:10.1186/1752-4458-8-47) contains supplementary material, which is available to authorized users.
doi:10.1186/1752-4458-8-47
PMCID: PMC4253997  PMID: 25473417
Diffusion of innovation; Institutional theory; Governance; Mental health policy
18.  A theory-informed approach to mental health care capacity building for pharmacists 
Background
Pharmacists are knowledgeable, accessible health care professionals who can provide services that improve outcomes in mental health care. Various challenges and opportunities can exist in pharmacy practice to hinder or support pharmacists’ efforts. We used a theory-informed approach to development and implementation of a capacity-building program to enhance pharmacists’ roles in mental health care.
Methods
Theories and frameworks including the Consolidated Framework for Implementation Research, the Theoretical Domains Framework, and the Behaviour Change Wheel were used to inform the conceptualization, development, and implementation of a capacity-building program to enhance pharmacists’ roles in mental health care.
Results
The More Than Meds program was developed and implemented through an iterative process. The main program components included: an education and training day; use of a train-the-trainer approach from partnerships with pharmacists and people with lived experience of mental illness; development of a community of practice through email communications, a website, and a newsletter; and use of educational outreach delivered by pharmacists. Theories and frameworks used throughout the program’s development and implementation facilitated a means to conceptualize the component parts of the program as well as its overall presence as a whole from inception through evolution in implementation. Using theoretical foundations for the program enabled critical consideration and understanding of issues related to trialability and adaptability of the program.
Conclusions
Theory was essential to the underlying development and implementation of a capacity-building program for enhancing services by pharmacists for people with lived experience of mental illness. Lessons learned from the development and implementation of this program are informing current research and evolution of the program.
doi:10.1186/1752-4458-8-46
PMCID: PMC4254206  PMID: 25473416
Community pharmacy; Mental illness; Behaviour Change Wheel; Consolidated Framework for Implementation Research
19.  Acute stress responses in Chinese soldiers performing various military tasks 
Background
To examine Chinese soldiers’ acute stress responses, we did this study.
Methods
The soldiers completed the Acute Stress Response Scale (ASRS) when engaged in major tasks, such as earthquake rescue in Wenchuan, Sichuan, and maintaining social stability in Urumchi, Xinjiang. The ASRS has good reliability and validity. The study enrolled 1,832 male soldiers.
Results
The results showed significant differences among five dimensions and the overall response index when comparing four diverse military tasks. Further analysis found that reduced work efficiency and 24 symptom clusters were significantly positively correlated.
Conclusions
The acute stress response of soldiers performing various tasks was influenced by many factors, including the task characteristics and external factors. In addition, the acute stress response affected their work efficiency.
doi:10.1186/1752-4458-8-45
PMCID: PMC4247674  PMID: 25435903
Chinese soldiers; Major tasks; Acute stress
20.  Excess cost of non-remission among outpatients with major depressive disorder 
Background
The purpose of this study was to assess the economic benefit of achieving remission among outpatients with major depressive disorder (MDD) who are currently employed in Korea.
Methods
Cross-sectional observational study. A total of 337 outpatients with MDD with paid jobs were recruited from 14 psychiatric clinics in Korea and were then divided into three groups as follows: new visit group (n = 128), remitted group (n = 100) and non-remitted group (n = 109). The 17-item Hamilton Depression Rating Scale (HAM-D) was used to decide whether a patient should be assigned to the remitted or non-remitted group. Direct medical and non-medical costs were measured via interview with the subjects. The World Health Organization Health and Work Performance Questionnaire (HPQ) were applied in order to measure the lost productive time (LPT) and related productivity costs.
Results
The three groups did not show a significant difference in direct medical cost. However, the difference between the remitted group and non-remitted group was statistically significant (25.49 ± 52.99 vs. 44.79 ± 126.55, χ2 = 12.99, p = 0.0015). The remitted group demonstrated a significant improvement in productivity (particularly presenteeism) when compared with the new visit group (Z = −3.29, p = 0.001). Although the non-remitted group received treatment at psychiatric clinics similar to the remitted group, it lost 33 more working hours per month, which is compatible to $332 per month.
Conclusion
These results suggest the economic importance of achieving remission in treating depression.
doi:10.1186/1752-4458-8-42
PMCID: PMC4246569  PMID: 25435902
Major depressive disorder; HPQ; Lost productive time; Presenteeism; Remission
21.  Social support moderates stress effects on depression 
This study examined the moderator effect of social support on the relationship between stress and depression of university students. A total of 632 undergraduate students completed the measures of perceived stress, perceived social support, and depression. Hierarchical regression analysis showed that social support moderated the association between stress and depression. Undergraduate students with high stress reported higher scores in depression than those with low stress with low social support level. However, the impact of stress on depression was much smaller in the high social support group compared with that in the low social support group.
doi:10.1186/1752-4458-8-41
PMCID: PMC4242489  PMID: 25422673
Stress; Social support; Depression; Moderating effect; University students
22.  Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use 
Background
Clients with severe mental illness (SMI) who use substances are less engaged in treatment than those who do not use substances, and assertive community treatment (ACT) engages and retains clients with SMI and concurrent substance use at a higher rate compared with traditional treatment. This qualitative study aimed to explore the experiences of being recruited to, and remaining in, ACT among recovering clients diagnosed with SMI and concurrent substance use.
Methods
Twenty semi-structured interviews were undertaken among 11 clients with SMI and concurrent substance use who were included in ACT teams. The inclusion criteria were SMI and concurrent substance use and improvement after a minimum of 12 months in treatment regarding one or several of the following parameters: quality of life, general functioning and substance use. Systematic text condensation was applied in the analyses.
Results
The experiences of building trust through enduring involvement and receiving benefits were most important for the acceptance of ACT by clients. A feeling of exclusiveness, perceiving ACT as a safety net and the clients’ own personal responsibility for taking part in the treatment were stated as the most important factors for remaining in treatment.
Conclusions
The implications of the results of the present study are that service providers have to prove that they can be trusted in the initial phase of the clients’ contact with the team. The feeling by clients with SMI and concurrent substance use that service providers in ACT believe they can improve their client’s quality of life, is of importance for feeling exclusive, having hope for the future and remaining in treatment.
doi:10.1186/1752-4458-8-40
PMCID: PMC4226907  PMID: 25389446
Severe mental illness; Substance use; Assertive community treatment; Client experiences; Engagement; Qualitative study
23.  Structural characteristics of specialised living units for people with dementia: a cross-sectional study in German nursing homes 
Background
Living units (LU) specialised for people with dementia are an important feature of nursing homes. Little is known about their structural characteristics, and an international definition is lacking. This study explored characteristics of the environment and staff from defined LU types to identify differences between them.
Design
Cross-sectional study comparing five types of LUs. LUs were defined based on their living concept (segregated and integrated), size (small and large scale), and funding (extra funded and not extra funded). Differences were identified using descriptive statistics, Chi-Square resp. Kruskal-Wallis-Test and post-hoc analysis with Bonferroni corrections.
Results
In total, 103 LUs from 51 nursing homes participated: 63 integrated and 40 segregated LUs; 48 integrated and 31 segregated LUs were large. Sixteen large segregated LUs were extra funded. Regarding the environment, a distinctive feature of small LUs was a higher percentage of single rooms. Small integrated LUs provided and served meals more in a homelike manner than other LUs. LUs did not differ in their interior and access for the residents to use outdoor areas. Regarding the staff, small LUs provided more staff, but they were not exclusively assigned to the LUs. Large segregated LUs with additional funding provided more registered nurses and nurses with a special qualification per resident than the other large LUs.
Conclusion
Nursing homes implemented different features in their specialised LUs. Because single room availability, homelike provision of meals, staff quantity, quality and continuity may influence residents’ outcomes, it is necessary to investigate whether differences are apparent in future evaluation studies of specialised LUs for people with dementia.
doi:10.1186/1752-4458-8-39
PMCID: PMC4213458  PMID: 25360154
Dementia; Dementia special care unit; Small-scale living unit; Structural characteristics
24.  Why should mental health have a place in the post-2015 global health agenda? 
Background
The tenure of the Millennium Development Goals formally expires in 2015 and will be replaced with a new development agenda. The MDGs did not include goals or targets for mental health. Despite gathering momentum during the last 15 years, mental health has not enjoyed the same pace of progress as the sectors explicitly mentioned within the MDGs. This article outlines the evidence indicating that mental health should be firmly positioned in post-2015 health policy and discusses strategies to advance the global mental health agenda.
Discussion
The interactions between mental health and other development goals are numerous and complex. Consequently, investment in mental health pays dividends on a wider level than simply psychiatric clinical outcomes. Mental health’s reciprocal relationship with poverty is consistent with the strong focus on economic development, rather than health in isolation, detailed in the post-2015 UN statements to date. A focus on the quality of mental health care provided in low and middle-income countries deserves priority in the new health agenda. This should include consideration of the accessibility of mental health care and the use of evidence based diagnosis and management in these settings.
Summary
Lack of investment in the mental health of populations is a key driver of poverty and inequality in low and middle-income countries. Renewed focus on mental health post-2015 is an opportunity to address the global burden of mental disorders and make a positive impact on the wider development agenda.
doi:10.1186/1752-4458-8-38
PMCID: PMC4252991  PMID: 25473415
25.  Professionals’ perceptions about healthcare resources for co-occuring disorders in Spain 
Background
Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and other psychiatric disorders) constitutes an important challenge, this study compared the perceptions of health-care professionals with the existing, current state of specific resources for patients with dual pathology in Spain.
Methods
Epidemiological, observational, cross-sectional, multicenter study with a large, representative sample of health care professionals attending patients with dual pathology in treatment resources throughout Spain. Participants completed a specifically designed ad-hoc on-line questionnaire about their perceptions on the existence of available resources and treatment needs for patients with dual pathology. To compare professionals’ perceptions with existing available resources, the same on-line questionnaire was also completed by commissioners and managers responsible for national and regional healthcare plans on drug abuse.
Results
A total of 659 professionals, mostly psychologists (43.40%) or psychiatrists (32.93%) agreed to participate in the study. The highest degree of concordance between the perceptions of professional and the actual situation was found regarding the existence of mental health and addiction networks (either separately or unified) (74.48%), followed by specific workshops (73.08%) and sub-acute inpatient units (67.38%), specific hospitalization units (66.26%), detoxification units (63.15%) and outpatient programs (60.73%). We detected a lower degree of agreement regarding specific occupational rehabilitation centers (59.34%) day hospitals (58.93%), day centers (57.88%), outpatient intermediate resources (48.87%), psychiatric acute admission units (46.54%) and therapeutic communities (43.77%). In addition, on average, health care professionals underestimated the number of resources present in their respective communities.
Conclusions
Relevant differences exist between the perceptions of professional and existing available resources for dual pathology patients in Spain, thus supporting the need of additional efforts and strategies to establish a registry and clearly inform about available resources for patients with dual diagnosis.
doi:10.1186/1752-4458-8-35
PMCID: PMC4158069  PMID: 25206926
Dual pathology; Dual disorders; Co-occurring disorders; Resources; Professionals’ perception; Mental health; Drug abuse

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