498 research outputs found
Adult attachment style as a risk factor for maternal postnatal depression: a systematic review
No full textBACKGROUND: Postnatal depression (PND) is an important health problem of global relevance for maternal health and impacts on the health and wellbeing of the child over the life-course. Multinational data is hard to locate, the economic burden of PND on health care systems have been calculated in several countries, including Canada and in the UK. In Canada, health and social care costs for a mother with PND were found to be just over twice that of mothers with no mental illness. The extra community care cost for women with PND living in the UK was found to be £35.7 million per year. METHOD: We carried out a systematic search to the literature to investigate the associations between attachment style and PND, using meta-narrative analysis methods, reporting statistical data and life narratives. The following databases were searched: PsycInfo, PsycExtra Web of Science, The Cochrane Library and Pubmed. We focused on research papers that examined adult attachment styles and PND, and published between 1991 and 2013. We included any papers showing relationship between maternal adult attachment and PND. Out of 353 papers, 20 met the study inclusion criteria, representing a total of 2306 participants. Data from these 20 studies was extracted by means of a data extraction table. RESULTS: We found that attachment and PND share a common aetiology and that 'insecure adult attachment style' is an additional risk factor for PND. Of the insecure adult attachment styles, anxious styles were found to be associated with PND symptoms more frequently than avoidant or dismissing styles of attachment. CONCLUSION: More comprehensive longitudinal research would be crucial to examine possible cause-effect associations between adult attachment style (as an intergenerational construct and risk factor) and PND (as an important maternal mental health), with new screening and interventions being essential for alleviating the suffering and consequences of PND. If more is understood about the risk profile of a new or prospective mother, more can be done to prevent the illness trajectory (PND); as well as making existing screening measures and treatment options more widely available
A case study of organisational cultural competence in mental healthcare
No full textAbstract Background Ensuring Cultural Competence (CC) in health care is a mechanism to deliver culturally appropriate care and optimise recovery. In policies that promote cultural competence, the training of mental health practitioners is a key component of a culturally competent organisation. This study examines staff perceptions of CC and the integration of CC principles in a mental healthcare organisation. The purpose is to show interactions between organisational and individual processes that help or hinder recovery orientated services. Methods We carried out a case study of a large mental health provider using a cultural competence needs analysis. We used structured and semi-structured questionnaires to explore the perceptions of healthcare professionals located in one of the most ethnically and culturally diverse areas of England, its capital city London. Results There was some evidence that clinical staff were engaged in culturally competent activities. We found a growing awareness of cultural competence amongst staff in general, and many had attended training. However, strategic plans and procedures that promote cultural competence tended to not be well communicated to all frontline staff; whilst there was little understanding at corporate level of culturally competent clinical practices. The provider organisation had commenced a targeted recruitment campaign to recruit staff from under-represented ethnic groups and it developed collaborative working patterns with service users. Conclusion There is evidence to show tentative steps towards building cultural competence in the organisation. However, further work is needed to embed cultural competence principles and practices at all levels of the organisation, for example, by introducing monitoring systems that enable organisations to benchmark their performance as a culturally capable organisation.</p
Estimation of inherent governor dead-band and regulation using unscented Kalman filter
No full textThe inclusion of the governor droop and dead-band in dynamic models helps to reproduce the measured frequency response accurately and is a key aspect of model validation. Often, accurate and detailed turbine-governor information are not available for various units in an area control centre. The uncertainty in the droop also arise from the nonlinearity due to the governor valves. The droop and deadband are required to tune the secondary frequency bias factors, and to determine the primary frequency reserve. Earlier research on droop estimation did not adequately take into account the effect of dead-band and other nonlinearities. In this paper, unscented Kalman filter is used in conjunction with continuously available measurements to estimate the governor droop and the dead-band width. The effectiveness of the approach is demonstrated through simulation
THERACOM : a systematic review of the evidence base for interventions to improve Therapeutic Communications between black and minority ethnic populations and staff in specialist mental health services
No full textBackground: Black and Minority Ethnic (BME) groups in receipt of specialist mental health care have reported higher rates of detention under the mental health act, less use of psychological therapies, and more dissatisfaction. Although many explanations have been put forward to explain this, a failure of therapeutic communications may explain poorer satisfaction, disengagement from services and ethnic variations in access to less coercive care. Interventions that improve therapeutic communications may offer new approaches to tackle ethnic inequalities in experiences and outcomes.
Methods: The THERACOM project is an HTA-funded evidence synthesis review of interventions to improve therapeutic communications between black and minority ethnic patients in contact with specialist mental health services and staff providing those services. This article sets out the protocol methods for a necessarily broad review topic, including appropriate search strategies, dilemmas for classifying different types of therapeutic communications and expectations of the types of interventions to improve them. The review methods will accommodate unexpected types of study and interventions. The findings will be reported in 2013, including a synthesis of the quantitative and grey literature.
Discussion: A particular methodological challenge is to identify and rate the quality of many different study types, for example, randomised controlled trials, observational quantitative studies, qualitative studies and case studies, which comprise the full range of hierarchies of evidence. We discuss the preliminary methodological challenges and some solutions. (PROSPERO registration number: CRD42011001661).
Keywords: Interventions, Therapeutic communications, Black and minority ethnic patients, Psychiatric service
The undeniable reality of the ‘war on terror’, radicalisation and sanity
No full textThis chapter explores the relationship between ‘structure, mental health (agency-emotions-trauma) and radicalisation’. It uses Cohen’s States of Denial as a Freudian meta narrative to explore how denial operates to protect individual’s sanity against the atrocities and suffering in the world. It demonstrates how the denials of injustice, suffering and erosion of human rights in the ‘war on terror’ are exposed by Islamists and form part of their counter narrative to the ‘war on terror’.
The chapter contends that this exposure of harmful realities leads to overwhelming emotions that individuals struggle to regulate, and it is the need for support, understanding and compassion in dealing with such emotions that leads individuals to seek out extremist groups. It is argued that public services must support emotional resilience, and the absence of these services represents a continuing academic and policy neglect of how societal structures and institutions impact individuals’ beliefs and emotions and form part of their experience of victimisation
A synthesis of the evidence for managing stress at work: a review of the reviews reporting on anxiety, depression, and absenteeism.
No full textBACKGROUND: Psychosocial stressors in the workplace are a cause of anxiety and depressive illnesses, suicide and family disruption. METHODS: The present review synthesizes the evidence from existing systematic reviews published between 1990 and July 2011. We assessed the effectiveness of individual, organisational and mixed interventions on two outcomes: mental health and absenteeism. RESULTS: In total, 23 systematic reviews included 499 primary studies; there were 11 meta-analyses and 12 narrative reviews. Meta-analytic studies found a greater effect size of individual interventions on individual outcomes. Organisational interventions showed mixed evidence of benefit. Organisational programmes for physical activity showed a reduction in absenteeism. The findings from the meta-analytic reviews were consistent with the findings from the narrative reviews. Specifically, cognitive-behavioural programmes produced larger effects at the individual level compared with other interventions. Some interventions appeared to lead to deterioration in mental health and absenteeism outcomes.Gaps in the literature include studies of organisational outcomes like absenteeism, the influence of specific occupations and size of organisations, and studies of the comparative effectiveness of primary, secondary and tertiary prevention. CONCLUSIONS: Individual interventions (like CBT) improve individuals' mental health. Physical activity as an organisational intervention reduces absenteeism. Research needs to target gaps in the evidence.This work was supported by the Department of Health in UK
to K. S. Bhui
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