From mental disorder to shared understanding: a non-categorical approach to support individuals with distress in primary care

Byng, Richard; Groos, Nora; Dowrick, Christopher

doi:10.3399/bjgp19x701777

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…Within the participants' psychiatric practice, the ICD-10 framework informed the diagnosis of a disorder -ICD-11 had not yet been published when this study was conducted. While there are ongoing debates on whether this diagnostic model leads to adequate representations of reality (Mellsop et al, 2007;Byng et al, 2019) and on challenges from exporting mental health expertise from Western to non-Western settings (Cooper, 2016;Cox and Webb, 2015), only a few participants showed similar concerns and questioned the lack of cultural context and determinants of health. The study showed that the psychiatrists found it difficult to identify with the MHA's approach due to its distinction between people suffering from mental problems and mental disorders.…”

Section: Barriers To Implementationmentioning

confidence: 99%

The Indonesian Mental Health Act: psychiatrists’ views on the act and its implementation

Bikker

Lesmana

Tiliopoulos

2020

Health Policy and Planning

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In 2014, the Indonesian government passed the Mental Health Act (MHA) to address the country’s complex mental health situation. The implementation of the MHA has been slow, and little is known about how the MHA is perceived by mental healthcare providers within local settings. This study aimed to obtain insight into psychiatrists’ views on the MHA, including on how it affected their clinical practice and on challenges of translating the MHA into practice. The study was conducted in Bali, and 27 psychiatrists (15 men and 12 women) participated in a semi-structured interview. Thematic analysis indicated four overarching themes: raising the profile of mental health, developing a shared understanding of mental illness, integrating psychiatric practice with other services and views on implementation of the MHA into practice. Overall, the psychiatrists viewed the MHA as a step in the right direction to improve mental health services and to create awareness at local and national levels. However, there was consensus that the meaning of the MHA’s concepts of mental problems and disorders were not compatible with psychiatric everyday practice or their patients’ understandings. As a result, many assumed that the MHA was targeted at government and policy officials. Furthermore, there was a perceived lack of clarity on issues relating to collaborating with other services and unequal access to resources among regencies that impacted on their clinical practice in a negative way. Moreover, a few psychiatrists raised concerns that local beliefs and practices were not acknowledged in the MHA. According to the participants, mental health remained a highly political issue and without national support, mental health would remain a low priority. In conclusion, insights into providers’ perspectives contribute to developing an evidence-base that can inform the implementation process of the MHA in Indonesia, and possibly elsewhere, into local level guidelines and regulations.

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Section: Barriers To Implementationmentioning

confidence: 99%

The Indonesian Mental Health Act: psychiatrists’ views on the act and its implementation

Bikker

Lesmana

Tiliopoulos

2020

Health Policy and Planning

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“…Models for assessment also vary greatly, from diagnostic criteria-based approaches (e.g. use of symptom questionnaires like the PHQ-9) 1 to calls for alternative non-categorical strategies based on shared understanding 8 (e.g. prioritising key issues facing the individual, how they link, and developing a shared action plan).…”

Section: Introductionmentioning

confidence: 99%

Distinguishing emotional distress from mental disorder in primary care: a qualitative exploration of the Four-Dimensional Symptom Questionnaire

Geraghty,

Holt,

Chew-Graham

et al. 2024

Br J Gen Pract

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Background: Primary care clinicians see people experiencing the full range of mental health problems. Determining when symptoms reflect disorder is complex. The Four-Dimensional Symptom Questionnaire (4DSQ) uniquely distinguishes general distress from depressive and anxiety disorders. It may support diagnostic conversations and targeting of treatment. Aim: We aimed to explore peoples’ experiences of completing the 4DSQ and their perceptions of their resulting score profile across distress, depression, anxiety and physical symptoms. Design and Setting: A qualitative study conducted in the UK with people recruited from primary care and community settings. Method: Participants completed the 4DSQ then took part in semi-structured telephone interviews. They were interviewed about their experience of completing the 4DSQ, their perceptions of their scores across four dimensions, and the perceived utility if used with a clinician. Interviews were transcribed verbatim and data were analysed thematically. Results: Twenty-four interviews were conducted. Most participants found the 4DSQ easy to complete and reported that scores across the four dimensions aligned well with their symptom experience. Distinct scores for distress, depression and anxiety appeared to support improved self-understanding. Some valued the opportunity to discuss their scores and provide relevant context. Many felt the use of the 4DSQ with clinicians would be helpful and likely to support treatment decisions, although some were concerned about time-limited consultations. Conclusion: Distinguishing general distress from depressive and anxiety disorders aligned well with people’s experience of symptoms. Use of the 4DSQ as part of mental health consultations may support targeting of treatment and personalisation of care.

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“…(16,19,29) Furthermore, within general practice there is ongoing debate as to whether classifying mental disorders is of benefit to the management of people with distress. (30) There is a gap in the literature on the experiences of people of SA origin with LTCs, and their experiences of emotional distress. This systematic review asked: how do people SA origin with long-term physical conditions understand, experience and seek help for emotional distress, depression and anxiety?…”

Section: Introductionmentioning

confidence: 99%

“… 16 , 19 , 29 Furthermore, within general practice there is ongoing debate as to whether classifying mental disorders is of benefit to the management of people with distress. 30 …”

Section: Introductionmentioning

confidence: 99%

Emotional distress, anxiety, and depression in South Asians with long-term conditions: a qualitative systematic review

et al. 2022

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People with physical-mental comorbidity have a poorer quality of life, worse clinical outcomes and increased mortality compared to people with physical conditions alone. South Asians (SAs) are the largest minority group in the UK and are more likely to have long-term conditions (LTCs) such as diabetes and heart disease. SAs are less likely to recognise symptoms which may represent mental health problems. To explore how people of SA origin with LTCs understand, experience and seek help for emotional distress, depression and anxiety. Systematic review of qualitative studies exploring emotional distress in SAs with diabetes or coronary heart disease, within primary and community care settings worldwide. Comprehensive searches of eight electronic databases from inception to 1st September 2021. Data extracted included study characteristics, and understanding, experience and help-seeking behaviour for emotional distress. Thematic synthesis was undertaken. The CASP checklist for qualitative studies was used to assess quality of papers, and GRADE-CERQual used to determine the overall strength of evidence. Twenty one studies from 3,165 unique citations were included. Three main themes were identified. Understanding of emotional distress: non-medical terminology used, such as ‘tension,’ and a complex relationship between emotional and physical illness. Experiences of emotional distress: multiple forms of inequality, distress at diagnosis of their LTC, cultural factors, and gender differences. Help-seeking behaviour: self-management, seeking help from family, friends, and faith, and inadequate clinical support. This review provides a greater understanding of SAs’ conceptualisation of emotional distress in the context of LTCs, to support improvement in its recognition and management.

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From mental disorder to shared understanding: a non-categorical approach to support individuals with distress in primary care

Cited by 8 publications

References 11 publications

The Indonesian Mental Health Act: psychiatrists’ views on the act and its implementation

The Indonesian Mental Health Act: psychiatrists’ views on the act and its implementation

Distinguishing emotional distress from mental disorder in primary care: a qualitative exploration of the Four-Dimensional Symptom Questionnaire

Emotional distress, anxiety, and depression in South Asians with long-term conditions: a qualitative systematic review

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