The P15 – a multinational assessment battery for collecting data on health indicators relevant to adults with intellectual disabilities

Background Health disparities between adults with intellectual disabilities (ID) and the general population have been well documented but, to date, no dedicated assessment battery for measuring health disparity has been available. This paper reports on the development and testing of a multinational assessment battery for collecting data on a range of health indicators relevant to adults with ID. Methods An assessment battery (the P15) was developed following piloting, and administered to samples of adults with ID, in 14 EU countries. Samples were neither random, nor representative of the countries from which they were drawn. However, within the local health administration areas selected in each country, efforts were made to ensure samples were broadly representative of the typical living circumstances, ages and ability levels of the administrative population of adults with ID. The total sample comprised 1269 adults with ID, of whom 49% were female. The mean age was 41 years (range 19 to 90). Results Overall, feasibility, internal consistency and face validity of the P15 was acceptable. Conclusions With some refinement the P15 could be useful for collecting data on health indicators known to be particularly important for adults with ID. It is useable in a range of countries and has the potential to highlight health inequity for adults with ID at a national or local level. Larger scale epidemiological studies are needed to exploit the potential of the P15 to address health inequity in this group.     

The mediating effect of self-efficacy on the relationship between health literacy and health status in Korean older adults: A short report

Objectives: Limited health literacy has been shown to be associated with poor health status. However, research to date has not elucidated the factors that mediate the relationship between low literacy and poor health outcomes. The purpose of this study was to examine the mediating effect of self-efficacy on the relationship between health literacy and health status in Korean older adults.

Method: A cross-sectional study of 103 community-dwelling Korean older adults was conducted from June 2007 to September 2007.

Results: The study found that low health literacy was associated with poorer physical and mental health status, and the effect of health literacy on physical and mental health status was mediated through self-efficacy.

Conclusion: The study suggests that interventions to improve the delivery of care for older adults with low health literacy need to include not only improving the readability of health-related materials, but also enhancing the self-efficacy of each individual.     

The prevalence of major depression or dysthymia among aged Medicare Fee-for-Service beneficiaries

RESEARCH OBJECTIVE: Estimates of the prevalence of major depression vary widely. Current estimates range from 2 to 14 % depending upon the definition and procedure for diagnosis. Further, most estimates are for special populations, either living in selected geographic areas or receiving specific types of medical care. A national survey of Medicare Fee-for-Service (FFS) beneficiaries provides an opportunity to assess the current level of major depression or dysthymia among a diverse population of older Americans. STUDY DESIGN: The Health Outcomes Survey (HOS) was administered to a national random sample of 1,000 Medicare FFS beneficiaries. We used the Mental Component Summary (MCS) measure of the SF-36 to estimate the prevalence of major depression or dysthymia. Logistic regression was used to examine associated factors. RESULTS: The response rate was 61.7%. Using an MCS score of 42 or lower, prevalence of major depression or dysthymia was estimated to be 25% for respondents age 65 years and older. Logistic regression analysis revealed that the likelihood of major depression or dysthymia was associated with years of education (Odds Ratio (OR) = 0.87), difficulties performing activities of daily living (OR = 1.72), and Medicaid enrollment (OR = 2.67). CONCLUSIONS: The results revealed that one-quarter of the respondents reported mental health problems consistent with major depression or dysthymia. This is higher than previously reported. Like previous studies, years of education, physical impairment, and poverty are strong predictors of major depression or dysthymia. The high rate of major depression or dysthymia implies there may be considerable unmet need among elderly Medicare FFS beneficiaries for diagnosing and treating mental illness.     

Health screening for people with intellectual disability: the New Zealand experience

People with intellectual disability have considerable health needs and variable health care. The introduction of annual health screens for IHC residents in New Zealand resulted in some 73% of screened people requiring follow-up interventions. The introduction of the health screens raised a number of issues for management, staff, health professionals and clients who might subsequently be involved in an exercise of this type and magnitude. The importance of applying principles of management promoted by proponents of total quality management has been apparent throughout the whole exercise.     

Cognitive impairment and syndromal depression in estimates of active life expectancy: the 13-year follow-up of the Baltimore Epidemiologic Catchment Area sample

OBJECTIVE: Our hypothesis was that including cognitive status and syndromal depression in specifying functional impairment would result in significant differences in estimates of active life expectancy from specifications that included only standard functional measures (such as activities of daily living). METHOD: The subjects were the 3481 continuing participants of the Baltimore Epidemiologic Catchment Area Program. Interviews included criterion-based diagnosis of depression, assessment of cognitive status and standard survey questions on function. RESULTS: Estimates of active life expectancy decreased from 9.8 years to 8.9 years at age 65 years for men, and from 10 years to 8.4 years at age 65 years for women, when the definition of active life expectancy included measures of cognitive impairment and syndromal depression. CONCLUSION: Measurements of active life expectancy tend to ignore dependencies related to psychological causes, and should move beyond mere enumeration of activities of daily living and instrumental activities of daily living.     

Cost estimation of a health-check intervention for adults with intellectual disabilities in the UK

Background   High rates of health needs among adults with intellectual disabilities flag the need for information about the economic consequences of strategies to identify and address unmet needs. Health-check interventions are one such strategy, and have been demonstrated to effect health gains over the following 12-month period. However, little is known about their effects on service use and costs, and hence how affordable such interventions are.
Methods   We examined service use patterns and costs over a 12-month period for 50 adult participants with intellectual disabilities who received a health-check intervention and 50 individually matched control participants who received standard care only.
Results   The health-check intervention was cheap, and it did not have associated higher costs in terms of service usage. Indeed, mean cost of care for the adults who received standard care only was greater than for the adults who received the health-check intervention. The higher costs were due to differences in unpaid carer support costs.
Conclusion   This is the first study to report the associated service use, and costs of a health-check intervention to improve the health of adults with intellectual disabilities and reduce health inequalities. Results suggest this intervention is cheap and affordable compared with standard care, supporting clinical outcome evidence for its introduction into health care policy and implementation. However, further research is needed to confirm this finding with a larger sample.     

The development of the Perth Charter for the Promotion of Mental Health and Wellbeing

The Perth Charter for the Promotion of Mental Health and Wellbeing is an initiative of the organizing committee of the 7th World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioural Disorders. An iterative feedback process was used to develop and revise the charter principles in consultation with health professionals. A final online survey showed strong support for each of the eight principles, which were rated ‘essential’ (as distinct from ‘desirable’ or ‘not relevant’) by 73–96% of respondents. The principles were supported most strongly by practitioners, of whom 85–100% classified each as ‘essential’. It is hoped that mental health professionals find the Charter useful for advocating for greater resource allocation in their jurisdictions to mental health, in general and to mental health promotion in particular.     

Reassessing Treatment Environments After Two Decades: Client and Staff Perceptions of an Italian Community Mental Health Service Environment, Then and Now

Community-based psychiatric services and programs developed in accordance with the 1978 Italian psychiatric reform have now been in operation for a quarter of a century. The paper presents the results of a study in which three treatment environments of South-Verona, i.e. a general hospital psychiatric ward, a community mental health center (CMHC) and two residential facilities have been investigated using the Ward Atmosphere Scale (WAS) and the Community Oriented Programs Environment Scale (COPES). Staff and patient ratings have been collected in the three environments thus allowing comparisons between respondents and settings. For the ward and the CMHC, whose staff had already been interviewed almost twenty years before, a comparison between studies was also possible. Results seem to show that original policies, attitudes and staff commitment have successfully survived the passage of time with only minor adjustments and that the single-staff module of South-Verona may have effectively contributed in this respect.     

Clinic-Level Process of Care for Depression in Primary Care Settings

Multi-component models for improving depression care target primary care (PC) clinics, yet few studies document usual clinic-level care. This case comparison assessed usual processes for depression management at 10 PC clinics. Although general similarities existed across sites, clinics varied on specific processes, barriers, and adherence to practice guidelines. Screening for depression conformed to guidelines. Processes for assessment, diagnosis, treatment, and follow-up varied to different degrees in different clinics. This individuality of usual care should be defined prior to quality improvement interventions, and may provide insights for introducing or tailoring changes, as well as improving interpretation of evaluation results. Presentation  This work has been presented as a poster of the same title at the Annual Meeting of Academy Health in Orlando, FL, June 2007.     

Inner-City Child Mental Health Service Use: The Real Question Is Why Youth and Families Do Not Use Services

OBJECTIVE: This study examines pathways to urban child mental health care as well as explores reasons why care was not received. METHODS: A single group longitudinal design was used to study initial attendance rates at an outpatient child mental health clinic and identify factors associated with initial service use for urban children and their families. RESULTS: Approximately one-third of families (n = 82) do not follow up with care despite their child being referred and an initial appointment scheduled. Yet, three-quarters of those who did not attend a first session still wanted services when interviewed. Factors most significantly related to service use were social support and parental skill efficacy. Miscommunication between adult caregiver and provider was the most often cited reason for non-attendance. CONCLUSIONS: There is a significant unmet need for care along with identification of significant barriers to access. Empirical findings can serve as the basis for modifying urban child mental health service delivery systems.     

Mental health expectancy — the European perspective: a synopsis of results presented at the Conference of the European Network for the Calculation of Health Expectancies (Euro-REVES)

The increase in life expectancy observed over the last decade has particular relevance for mental health conditions of old age, such as dementia. Although mental disorders have been estimated to be responsible for 60% of all disabilities, until recently population health indicators such as health expectancies have concentrated on calculating disability-free life expectancy based on physical functioning. In 1994, a European Network for the Calculation of Health Expectancies (Euro-REVES) was established, one of its aims being the development and promotion of mental health expectancies. Such indicators may have an important role in monitoring future changes in the mental health of populations and predicting service needs. This article summarizes the proceedings and recommendations of the first European Conference on Mental Health Expectancy.     

Narrative Matters: Hidden LIVE – Adam's story – a mental health theatre production as an example of participatory principles and practices

This article presents the co-production principles underpinning the co-creation of a multimedia theatre production on young people's mental health.     

Mental health literacy among young people in a small US town: recognition of disorders and hypothetical helping responses

Aim: Mental health literacy may be a factor in early detection and prompt treatment for mental, emotional and behavioural disorders among young people. Building on previous research in Australia, this study assessed aspects of mental health literacy among adolescents in classrooms in a small town in the eastern USA. Methods: The students were provided brief, hypothetical, gender-matched scenarios about adolescents experiencing negative emotions and exhibiting related behaviours; some scenarios depicted diagnosable disorders. The respondents were asked to characterize each scenario as describing a mental health problem or other teen problem and indicate how they would respond to a peer who had such a problem. Results: Overall levels of recognition of mental disorders were low (27.5% identified anxiety and 42.4% identified depression as ‘a mental health problem or illness’). However, the respondents who recognized a disorder were three to four times more likely than those who did not to say they would take some helping action, such as telling an adult about the problem (depression: odds ratio 3.27; CI 1.43–7.46, anxiety: OR 4.43; CI 2.23–8.79). Few students (27.7%) remembered in-class discussions of mental health, a mandated health topic for schools in their area. Conclusions: There appears to be substantial room for improvement in mental health literacy among young people, and the development of interventions to enhance mental health literacy among students may be justified.     

The Seychelles Dental Service

The Seychelles Dental Service dates back to the 1920s, growing from rudimentary dentistry to the evidence-based dentistry of today. Until the 1970s, dental care was provided by a small number of dentists. However, since the establishment of the School Dental Service (SDS) in the 1980s, child oral health has been the responsibility of Dental Therapists (DTs). Today Seychelles has a well organised oral health care system in place with modern infrastructure and equipment and trained personnel. Locally trained DTs constitute 85% of the SDS workforce. A national oral health plan serves as a guide to ensure that programmes are developed in accordance with WHO global oral health goals, guided by periodic reviews. We present a resume of the major strengths and challenges of the Seychelles Dental Service, concluding with recommendations for staff development. Findings and recommendations of reviews and assessments of various dental health issues conducted in the country between 1977 and 1999 are summarised in the appendix.     

综合医院住院患者的自测健康状况及影响因素分析

目的了解综合医院住院患者的自测健康状态及其影响因素。方法选择综合医院符合条件的住院患者，科室测评名额按其现有住院人数比例分配。由受过培训的专业人员对患者进行指导自评，患者躯体疾病的严重程度，由经治医生评定。结果综合医院住院患者的自测健康较低，不同性别、已未婚、有无职业、职业是否稳定及不同居住地之间存在显著差别，年龄、受教育程度和疾病严重性对自测结果影响明显，呈显著相关。经治医生对躯体疾病严重程度的评价与患者自测健康的结果是一致的。结论综合医院住院患者的健康状况不仅包括躯体健康，同时也包括心理和社会健康，关注患者的健康，要同时关注他的躯体、心理和社会健康一．     

Prevalence,incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study

Purpose: To explore the association of major depressive symptoms with advancing age, sex, and self-rated health among older adults.

Design and methods: We analyzed 10 years of annual assessments in a longitudinal cohort of 5888 Medicare recipients in the Cardiovascular Health Study. Self-rated health was assessed with a single question, and subjects categorized as healthy or sick. Major depressive symptoms were assessed using the Center for Epidemiologic Studies Short Depression Scale, with subjects categorized as nondepressed (score < 10) or depressed (≥10). Age-, sex-, and health-specific prevalence of depression and the probabilities of transition between depressed and nondepressed states were estimated.

Results: The prevalence of a major depressive state was higher in women, and increased with advancing age. The probability of becoming depressed increased with advancing age among the healthy but not the sick. Women showed a greater probability than men of becoming depressed, regardless of health status. Major depressive symptoms persisted over one-year intervals in about 60% of the healthy and 75% of the sick, with little difference between men and women.

Implications: Clinically significant depressive symptoms occur commonly in older adults, especially women, increase with advancing age, are associated with poor self-rated health, and are largely intransigent. In order to limit the deleterious consequences of depression among older adults, increased attention to prevention, screening, and treatment is warranted. A self-rated health item could be used in clinical settings to refine the prognosis of late-life depression.     

Supervision Practices in Allied Mental Health: Relationships of Supervision Characteristics to Perceived Impact and Job Satisfaction

This study examined whether supervision characteristics impacted on mental health practice and morale, and developed a new Supervision Attitude Scale (SAS). Telephone surveys were conducted with a representative sample of 272 staff from public mental health services across Queensland. Although supervision was widely received and positively rated, it had low average intensity, and assessment and training of skills was rarely incorporated. Perceived impact on practice was associated with acquisition of skills and positive attitudes to supervisors, but extent of supervision was related to impact only if it was from within the profession. Intention to resign was unrelated to extent of supervision, but was associated with positive attitudes to supervisors, accessibility, high impact, and empathy or praise in supervision sessions. The SAS had high internal consistency, and its intercorrelations were consistent with it being a measure of relationship positivity. The study supported the role of supervision in retention and in improving practice. It also highlighted supervision characteristics that might be targeted in training, and provided preliminary data on a new measure.