Depression, together with suicide is an important contributor to the burden of disease in Thailand. Until recently, depression has been significantly under-recognized in the country. The lack of response to this health challenge has been compounded by a low level of access to standard care, constraints on mental health personnel and inadequate dissemination of knowledge in caring for people with these disorders. In the past decade, significant work has been undertaken to establish a new evidence-based surveillance and care system for depression and suicide in Thailand that operates at all levels of health-care provision nationwide. The main components of the integrated system are: (i) community-level screening for depression in at-risk groups, using a two-question tool; (ii) assessment of the severity of depression using a nine-question scale; (iii) diagnosis and treatment by general practitioners; (iv) psychosocial care provided by psychiatric nurses; (v) continuous care for relapse and suicide prevention; and (vi) promotion of mental well-being and prevention of depression in at-risk populations. Factors such as appropriate financial mechanisms, capacity-building programmes for health-care workers, and robust treatment guidelines have contributed to the success and sustainability of this comprehensive surveillance and care system. By 2016, more than 14 million people at risk had been screened for depression and received mental health education; more than 1.7 million people with depression had received psychosocial interventions; 0.7 million diagnosed patients had received antidepressants; and 0.8 million were being followed up for relapse and suicide prevention. The application of this surveillance and care system has led to an enormous increase in the accessibility of standard care for people with depressive disorders, from 5.1% of those with depressive disorders in 2009 to 48.5% in 2016.
Background: Studies examining individual obstetric complications with the strongest associations with schizophrenia have the potential to help elucidate the etiology of schizophrenia, both by pointing the way to molecular studies and through an examination of their synergistic interaction with other risk factors. Here, we update our previous systematic review and meta-analysis on the association between obstetric complications and schizophrenia (Cannon et al, 2002) and examine individual obstetric complications of note. Methods: We conducted a systematic review of all published literature using Medline, Embase, and PubMED, searched the reference lists of published paper, and contacted authors in the field. In keeping with our previous meta-analysis, new studies were included only if they had prospective population-based data. Obstetric complications that were examined in 2 or more studies were included. Results: Low birth-weight and unwantedness of pregnancy were examined in 2 or more population-based studies since 2002. The pooled OR for the association between low birth-weight (<2500 g) and schizophrenia was 1.1 (95% CI: 0.6-1.6), indicating that there was no significant increase in the odds of those with a low birth-weight developing schizophrenia compared to those within the healthy birth-weight range. The pooled OR for the association between unwanted pregnancy and schizophrenia was 1.8 (95% CI: 1.1-2.5), indicating a 1.8-fold increase in the odds of those whose mothers described the pregnancy as unwanted developing schizophrenia compared to those who whose mothers did not describe the pregnancy as unwanted. There was very low heterogeneity in effect sizes across studies for both of these associations. Conclusion:This work provides epidemiological evidence of the importance of investigating key prenatal risk factors and the importance of psychological factors during pregnancy that may affect both maternal and fetal well-being. Reference Cannon M, Jones PB, Murray RM. Obstetric complications and schizophrenia: historical and meta-analytic review. Am J Psychiatry. 2002;159(7):1080-92. SU58. SEVERE MENTAL ILLNESS: WHERE TO IMPROVE QUALITY OF DIABETES MELLITUS CAREAnita Toender*, Mogens Vestergaard, Trine Munk-Olsen, and Thomas Munk Laursen Aarhus University Background: Severe mental illness (SMI) constitutes a high risk of physical morbidity and physical-related mortality, especially related to diabetes mellitus. Disparities in access to high-quality diabetes mellitus care are suggested to explain a major part of the higher mortality, but information about where to intervene specifically is needed. Hence, we aim to examine if persons with SMI and diabetes mellitus are treated with new improved antiglycemic medication to a lesser degree than persons with diabetes mellitus only. Methods: We will perform a cohort study and use national populationbased registers to identify and follow persons with SMI, type 2 diabetes mellitus and examine their use of the new improved anti-glycemic medication (dipeptidyl peptida...
Aims Most research exploring the link between traumatic events and psychotic experiences has focused on either Australia, Europe or North America. In this study, we expand the existing knowledge to Thailand and investigate the impact of the type and the number of traumatic events on psychotic experiences in Thailand. Methods We used data from the nationally representative 2013 Thai National Mental Health Survey (TNMHS), including questions on traumatic events and psychotic experiences. We regressed the lifetime experience of hallucinations or delusions against the following independent variables: the experience of any traumatic event during lifetime (dichotomous; hypothesis 1); the experience of either no traumatic event, one interpersonal, one unintentional or both interpersonal and unintentional traumatic events (categorical; hypothesis 2) and the number of traumatic events experienced during lifetime (categorical; hypothesis 3). We adjusted the regression models for sociodemographic indicators and psychiatric disorders, and considered survey weights. Results About 6% (95% confidence interval: 4.9–7.0) of the respondents stated that they had either hallucinatory or delusional experiences during their lifetime. The risk of reporting such experiences was more than doubled as high among respondents who had experienced at least one traumatic event during their lifetime than among those who had not yet experienced one, with higher risks for interpersonal or multiple traumatic events. Our results further indicated an increase in the risk of psychotic experiences as the number of traumatic events increased, with up to an eight-fold higher risk for people exposed to five or more traumatic events in their lifetime, compared to those with no traumatic events. Conclusions Individuals reporting interpersonal or multiple traumatic events face much higher risk of psychotic experiences. Effective and widely accessible secondary prevention programmes for people having experienced interpersonal or multiple traumatic events constitute a key intervention option.
Background Intensive case management (ICM) programmes for psychotic patients are effective in improving outcomes, but often unfeasible in resource-poor settings, as they typically require extensive human resources and expertise. We developed and evaluated the effectiveness of a less intensive case management program (LICM), led by community health workers, on one-year social functioning and service use. Methods A prospective cohort study was conducted on patients aged 18 and above residing in a hospital catchment area. Outcomes were compared between LICM (n = 64) and non-LICM participants (n = 485). A counterfactual framework approach was applied to assess causal effects of the LICM on outcomes. The programme effectiveness was analyzed by augmented-inverse probability of treatment weighting (AIPW) to estimate potential outcome mean (POM) and average treatment effect (ATE). Outcomes were employment status and use of emergency, inpatient and outpatient services. Analyses were stratified by the number of previous psychotic relapse (≤ 1, > 1) to assess heterogeneity of treatment effect on those in an early and later stages of psychotic illness. Results In the early-stage cohort, the likelihood of being employed at one year post-baseline was significantly greater in LICM participants than non-LICM participants (ATE 0.10, 95%CI 0.05–0.14, p < 0.001), whereas service use of all types, except outpatient, was not significantly different between the two groups. In the later-stage cohort, the likelihoods of employment between the two groups at post-baseline were similar (ATE -0.02, 95%CI -0.19–0.15, p = 0.826), whereas service use of all types was significantly higher in LICM participants. Conclusion LICM in a setting where community mental services are scarce may benefit those at an early stage of psychotic illness, by leading to better social functioning and no higher use of unscheduled services at the end of the programme, possibly through their better prognosis and medication adherence. A more intensive case management model may be appropriate for those in a later stage of the illness.
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