Volume 3, Issue 2, Summer and Autumn 2020
2020, Volume 3, Issue 2, Pages 113-118
Across four decades of war and violence in Iraq between 1981 and 2003, I undertook my medical training in psychiatry. I chose this specialty in response to the suffering of the bereaved women in Iraq across these rough times. This article details a personal history of my journey specialising in psychiatry through this period in Iraq and the experience of being the first female psychiatrist who accomplished her training through the Iraqi Board of Psychiatry in a programme established in 1988. I reflect on how psychiatry was not the specialisation of choice for female doctors, which created a shortage in the field. This most acutely impacted female trauma victims, who preferred to be treated by female psychiatrists. From the 1950s to 1988, the ratio of psychiatrists in the country increased from 0.2 to 0.5 per 100,000 population. However, this saw a dramatic decrease because of two waves of migration in 1991 and 2003, as of 1998, the ratio of psychiatrists in the country had dropped to 0.1 per 100,000 of the population. The pursuit and development of this specialisation were disrupted by war, invasion and comprehensive sanctions. I also consider the socio-economic impact of these aforementioned events on society as a whole and, in particular, on the medical profession. This account tells the story of my lived experience during those difficult times and my efforts to become an example of a new generation of women psychiatrists.
High variability of the current mental health practices around the globe: Twenty days in the lives of psychiatrists and other mental health care professionals from all over the world
2020, Volume 3, Issue 2, Pages 119-140
Introduction: The present is the future of the past, and the past of the future. This journal as well as this paper endeavour to document
the lives and practices of psychiatrists and other mental health care professionals for the future mental health community and to help
the clinicians of the future to understand the history and practice of psychiatry and mental health care in 2019/20. We, therefore, report
the current days in the lives of psychiatrists and other mental health care professionals.
Material and Methods: To obtain reports of days in the lives of psychiatrists and other mental health professionals, we published the
request on eight occasions from May 2019 to May 2020. We invited the prospective respondents/participants to send a relevant report
of their psychiatric practice in a day with a maximum word count of 750 words.
Results: We received 20 reports of variable lengths from 10 countries from six continents, including from psychiatrists, psychiatrists
in training, clinical psychologists and from medical students about their psychiatric training. The reports revealed a wide and highly
variable range of psychiatric and mental health practices, experiences and expectations. Last but not least, the reports we received were
informative and provided much information to reflect on.
Conclusions: There is a common strong commitment to support patients with mental health problems, but the ways this is achieved
are so diverse that generalisations about a typical common practice seem impossible. Future studies should focus more systematically
on the procedures and practices applied in helping patients with mental health problems in different countries and communities. This
knowledge might eventually help identify the procedures and services that are most efficient and helpful in various clinical contexts.
2020, Volume 3, Issue 2, Pages 141-168
Objective: The aim of this scoping review is to map the current landscape of published research and perspectives on physician suicide. Findings could serve as a roadmap for further investigations and potentially inform efforts to prevent physician suicide.
Methods: Ovid MEDLINE, PsycINFO, and Scopus were searched for English-language publications from August 21, 2017 through April 28, 2018. Inclusion criteria were a primary outcome or thesis focused on suicide (including suicide completion, attempts, and thoughts or ideation) among medical students, postgraduate trainees, or attending physicians. Opinion articles were included. Studies that were non-English or those that only mentioned physician burnout, mental health, or substance use disorders were excluded. Data extraction was performed by two authors.
Results: The search yielded 1,596 articles, of which 347 articles passed to the full-text review round. The oldest article was an editorial from 1903; 210 (60.3%) articles have been published from 2000 to present. Authors originated from 37 countries, and 143 (41.2%) were opinion articles. The most discussed were suicide risk factors and culture of practice issues, while the least discussed themes included public health and postvention.
Conclusions: Consistency and reliability of data and information about physician suicides could be improved. Data limitations partly contribute to these issues. Also, various suicide risk factors for physicians have been explored, and several remain poorly understood. Based on this scoping review, a public health approach, including surveillance and early warning systems, investigations of sentinel cases, and postvention may be impactful next steps in preventing physician deaths by suicide.
Factor structure of the Albanian version of the Clinical Assessment Interview for Negative Symptoms (CAINS): Associations with the Brief Symptoms Inventory (BSI)
2020, Volume 3, Issue 2, Pages 169-191
Objectives: The measurement and assessment of the emergent symptoms in various psychotic disorders is essential to the delivery of efficacious, patient centred mental health care. Despite the existence of several instruments that can measure these factors, their applicability within a global context remains undetermined. This paper aims to provide evidence for a factor structure in Clinical Assessment Interview for Negative Symptoms (CAINS), tailored for use in the Albanian language.
Methods: We recruited 106 patients with psychosis (68% male), who were aged 16 to 40 years old (M = 22, SD = 1.75), and treated in community services in Kosovo. We adapted, translated, and back-translated CAINS and the Brief Symptom Inventory (BSI) before these measures were administered in interviews with the participants. According to Kaiser-Guttman’s criterion (i.e., eigen-value >1), four components were extracted from the original measure of CAINS.
Results: Using Principal Component Analysis, CAINS was found to be a valid means of measurement of motivation and pleasure in various life domains (social, recreational, and work/school). Intercorrelation existed not only between the BSI scale and the CAINS scales, but within the CAINS scales themselves.
Conclusions: In contrast to the previous studies that found Expression and Motivation and Pleasure as two major factors, our results revealed four components. Thus, it may be that the culture plays a substantial role in the factor structure of CAINS, and it might be related to different appraisal of emotional situations, which are influenced by different socio-cultural practices. These results have global implications for clinical practice and future research.
Lack of Association between Academic Achievement and Social Phobia among High School Students of Kathmandu
2020, Volume 3, Issue 2, Pages 192-200
Objectives: The general objective of this research was to see if academic achievement significantly relates with social anxiety of high school students. There were other specific and auxiliary objectives also. One among these was to gather prevalence data of social anxiety among adolescents of Kathmandu.
Method: A survey was conducted among 696 high school students of Kathmandu to see if academic achievement was associated with their social phobia. Convenient sample from a high school was used. Social Phobia Inventory (SPIN), a self-report test, was used to measure social anxiety disorder of adolescent students. Some demographic data were also collected. Data were organized in MS Excel and analysed in SPSS.
Results: The prevalence of ‘very severe’ social phobia among boys was 2.01% and girls had that of 1.71%. One-way ANOVA showed that academic achievement did not have a relationship with social phobia, F (2, 613) = 1.74, p > 0.05.
Conclusions: Academic achievement was not associated with social phobia among students of a high school in Kathmandu. Boys have more prevalence of severe forms of social anxiety than girls when they are in adolescence.
How to measure the impact of the COVID-19 pandemic on quality of life: COV19-QoL –the development, reliability and validity of a new scale
2020, Volume 3, Issue 2, Pages 201-210
Objective: The primary objective of this paper is to present a short measure of perceptions on the impact of the COVID-19 pandemic on quality of life, along with analysis of its reliability and validity in non-clinical and clinical samples.
Methods: The scale was named The COV19 – Impact on Quality of Life (COV19-QoL) and it consists of six items presented in the form of a 5-point Likert scale. The items (i.e. statements) cover main areas of quality of life with regard to mental health. The scale was administered to 1346 participants from the general population in Croatia (the non-clinical sample) and 201 patients with severe mental illness recruited from four European countries (Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia), constituting the clinical sample. The clinical sample was part of the randomised controlled trial IMPULSE funded by the European Commission. Data on age and gender were collected for both samples, along with psychiatric diagnoses collected for the clinical sample.
Results: Main findings included a high internal consistency of the scale and a moderate to strong positive correlation among participants’ scores on different items. Principal component analysis yielded one latent component. The correlation between participants’ age and their results on COV19-QoL was negligible. Participants’ perceived quality of life was the most impacted domain, whereas mental health, personal safety and levels of depression were the least impacted domains by the pandemic.
Discussion: The COV19-QoL is a reliable and valid scale which can be used to explore the impact of COVID-19 on quality of life. The scale can be successfully used by researchers and clinicians interested in the impact of the pandemic on people experiencing various pre-existing mental health issues (e.g. anxiety, mood and personality disorders) as well as those without such issues.
A Multinational Pilot Study on the Lived Experiences and Mental Health Impacts from the COVID-19 Pandemic
2020, Volume 3, Issue 2, Pages 211-226
Objectives: To conduct a pilot study on the lived experiences of people affected by the COVID-19 pandemic, and the mental health impacts of the COVID-19 pandemic on affected people.
Methods: This mixed methods study used random and snowball techniques to recruit 91 respondents (age range 18–58 years) from 14 countries. Accessing patients with COVID-19 was restricted because of the nature of the disease and the treatment they were receiving which limited their access to being selected for our pilot study. Therefore, our respondents were members of the general population who were directly or indirectly affected by the pandemic. Respondents completed online surveys consisting of the Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9) and open-ended questions. Collected data were subjected to IBM SPSS
statistics software (v. 22.0) and thematic analysis.
Results: Both quantitative and qualitative instruments reported very high feasibility, which is suggestive of an excellent feasibility of our mixed methods design. Second, we identified financial and time resources as major barriers to the recruitment process, and how to avert these in the main study was discussed. Third, COVID-19 pandemic had more anxious than depressive impacts on our respondents. We also found that more than half (58, 63.7%) of the total respondents showed high knowledge level of COVID-19, and the major sources from which they gained knowledge were television, radio, and online academic papers. Our qualitative insight showed five themes from the lived experiences of respondents from the COVID-19 pandemic. These themes were; changes in lifestyles, disruption of schooling activities, impact on options for health services, disruption of works and economy, and anxious and worrisome impacts, in that order.
Conclusion: Main study is feasible with minor addition required on our protocol. Given other findings, we recommend the need for adaptive coping skill training, and appropriate information sharing during pandemics. There is also the need for psychosocial preparation due to the uncertainty of pandemics. In addition, averting the likely adverse economic impacts from pandemics should be of concern to governments and other stakeholders during pandemics. Finally, we recommend that governments and other stakeholders should be cautious about the likelihood of limited health service options for the general public during pandemics.
Depression in adolescents exposed to war trauma Risk factors for development of depression in adolescents exposed to war trauma: does PTSD matter?
2020, Volume 3, Issue 2, Pages 227-240
Background: Depression is frequently comorbid with posttraumatic stress disorder (PTSD) and substantially influences its severity, course and outcomes. Published studies linking war-related paediatric PTSD and Major depressive disorder (MDD) were mainly based on cross-sectional studies.
Objective: To prospectively examine the role of PTSD and other risk/protective factors in the development of depression among adolescents with war-related trauma.
Methods: A longitudinal study of 160 adolescents aged 15–17 years with war-related trauma and displacement due to war in Eastern Ukraine was performed. Of the 160 adolescents, N = 86 met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-4) criteria for PTSD. All adolescents underwent comprehensive psychiatric assessments that included Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL) administered to both parents and children. Traumatic exposure was assessed using the modified Traumatic Events Screening Inventory for children (TESI-C). PTSD and MDD were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) and Children’s Depression Rating Scale-Revised (CDRS-R), and diagnosed using DSM-4 criteria. Follow-up and repeated measurements occurred at 6 and 12 months. During the study, adolescents requiring clinical care were referred for best available care in the community.
Results: Among 92.6% of study completers, 26/79 youth with PTSD developed MDD (32.9%), compared to 6/70 without PTSD (8.5%): relative risk (RR) = 3.83 (95% CI 1.67-8.78), p = 0.0014; Number needed to harm (NNTH) = 4.108 (8.53–2.7). Using logistic regression, variables of school attendance, ‘secondary’ traumatic exposure, and treatment with Trauma-focused Cognitive Behavioral Therapy (TF-CBT) were significantly correlated with the incidence of new-onset depression among adolescents with PTSD.
Conclusions: War-related trauma with subsequent PTSD appears to be a significant risk factor for the later development of depression in adolescents. The role of PTSD as a moderator of depression merits further investigation in larger scale longitudinal studies in diverse populations.
Effect of dance movements on stereotype and repetitive behaviours of cases with autism spectrum disorder
2020, Volume 3, Issue 2, Pages 241-248
Objective: The objective of the study was to observe the effects of dance movements on stereotypical and repetitive behaviours of children diagnosed with autism spectrum disorder (ASD).
Method: The sample consisted of 5 patients within the age range of 9 to 16 years. Of the pool of 15 patients, 5 were lying in the range of moderate autism spectrum disorder with a higher score on stereotypical and repetitive behaviours. There were three male and two female patients. The cases were regularly coming to the day care centre of a hospital located in the southern part of India. Participants were assessed by Autism Spectrum Screening Questionnaire (ASSQ) and BASIC-MR Part-B. Dance movement intervention was planned for these five cases.
Results: Pre- and post-test scores were taken to observe the effects of dance movements on their behaviours. Fifteen sessions with a duration of 60 minutes per session were given. The results showed improvement in the repetitive behaviour in the sample, in which of these five, three showed greater improvement.
Conclusion: Hence, the result shows that dance movement could be used as an effective method to improve stereotypical and repetitive behaviour in children diagnosed with ASD.
2020, Volume 3, Issue 2, Pages 249-254
Objectives: Media reporting has an influential role in panic buying (PB). We aimed to evaluate the media portrayal of PB during this COVID-19 pandemic.
Methods: We searched, collected, and analysed the news reports from the English media discussing the PB events. The search was done between 23 and 30 May 2020.
Results: A total of 525 news reports were analysed. Approximately half (49.3%) discussed the government action to handle the situation, 36.4% discussed the expert opinion regarding PB, 20.6% discussed the psychology of PB, 21.5% discussed the rumours, and 18.5% suggested remedial measures. Concerning the negative aspects, 96.6% of the titles mentioned panic buying, 75.4% mentioned the cause, and 62.3% mentioned the photos of empty shelves. The media in low–middle-income countries are 1.5 times more likely to include expert opinion (p = 0.03), 2.1 times more likely to discuss rumours regarding PB (p = 0.001), almost thrice more likely to report the cause of PB (p = 0.001), and thrice more likely to mention its impact (p = 0.001).
Conclusion: Media has been portraying more negative aspects of PB. Further, there are variations in reporting patterns between highincome and low–middle-income countries.