Background and Aims: The purpose is to highlight the legal and ethical principles that inspired the reform of mental health care in Italy, the only country to have closed its psychiatric hospitals. The article will also try to verify some macro-indicators of the quality of care and discuss the crisis that the mental health care system in Italy is experiencing. Methods: Narrative review. Results: The principal changes in the legislation on mental health care in Italy assumed an important role in the evolution of morals and common sense of the civil society of that country. We describe three critical points: first, the differences in implementation in the different Italian regions; second, the progressive lack of resources that cannot be totally attributed to the economic crisis and which has compromised application of the law; and finally, the scarce attention given to measurement of change with scientific methods. Conclusion: Italy created a revolutionary approach to mental health care in a historical framework in which it produced impressive cultural expressions in many fields. At that time, people were accustomed to 'believing and doing' rather than questioning results and producing research, and this led to underestimating the importance of a scientific approach. With its economic and cultural crisis, Italy has lost creativity as well as interest in mental health, which has been guiltily neglected. Any future humanitarian approach to mental health must take the Italian experience into account, but must not forget that verification is the basis for any transformation in health care culture.
Background: Public beliefs about appropriate treatment impact, help-seeking and treatment adherence. Aim: To determine the recommendations of the Sardinian public for the treatment of depression. Methods: In 2012, a population-based survey was conducted by phone in Sardinia ( N = 1,200). In the context of a fully structured interview, respondents were presented with a vignette depicting a case of depression. Subsequently, they were asked about their treatment recommendations. The results are contrasted with findings from a similar survey which had been conducted in Vienna 3 years before. Results: In Sardinia as in Vienna, psychotherapy was the uncontested favorite, while antidepressant medication was recommended by relatively few respondents. In Sardinia, there were also no marked differences between urban and rural areas with regard to these two treatments. However, between Sardinia and Vienna, as well as within Sardinia, great differences were found with regard to autogenic training and 'alternative' methods like homeopathic medicines and acupuncture. Conclusion: Cross-cultural comparisons may help better understand treatment preferences of the public. In Sardinia, as in Vienna, there seems to be a need for improving the public's knowledge about the appropriate treatment of depression.
Background:It is difficult to quantify the impact of the COVID-19 pandemic on mental health as many community surveys have limited quality, rely on screening tests to measure mental health conditions and distress, and often use convenience samples. Moreover, robust surveys come mainly from high-income countries.Aim:To measure the prevalence of depressive disorders with onset during the pandemic in a community of a Lower-Middle-income country (LMIC)-Tunisia.Methods:Clinical semi-structured face-to-face interviews were carried out during the pandemic (September–December 2021) by medical doctors among a representative sample of the general population in the governorate of La Manouba, Tunisia. Psychiatric diagnoses were established according to DSM-IV.Results:The prevalence of Major Depressive Disorder (MDD) started or recurred after the pandemic was 5.66%. The factors associated with MDD were loss of job and considerably diminished income due to the pandemic (OR = 2.1, 95% CI [1.5, 2.9]) and the perception of having the family's financial situation below the Tunisian average (OR = 2.3, 95% CI [1.7, 3.2]). Female sex, marital status as separated/divorced, and having a COVID-19 infection were associated with MDD only in the overall sample and urban areas, but not in rural areas. Age and having loved ones who passed away due to COVID-19 were not associated with MDD.Conclusion:In Tunisia, the pandemic seems to have increased the risk of depression in people experiencing a precarious financial situation, also due to the pre-existing economic crisis. Specific local level factors, such as not establishing a rigid lockdown for an extended period, may have protected young people and allowed for better mourning in families suffering the loss of a loved one.
Objective: To ascertain lifetime prevalence of positivity to a screening questionnaire for bipolar disorders (BD) in Sardinian immigrants to Argentina and residents of Sardinia and assess whether such positivity affects quality of life (QoL) in either group. Our hypothesis is that screen positivity for BD may be more frequent in immigrants. Methods: Observational study. Subjects were randomly selected from the membership lists of associations of Sardinian immigrants in Argentina. A study carried out in Sardinia using the same methodology was used for comparison. The Mood Disorder Questionnaire was used to screen for mania/hypomania and the Short-Form Health Survey-12 to measure QoL. Results: A higher prevalence of manic/hypomanic episodes was found in Sardinian immigrants to Argentina (p < 0.0001; odds ratio = 3.0, 95% confidence interval 1.87-4.77). Positivity at screening was associated with a lower QoL both in Sardinian immigrants to Argentina and in residents of Sardinia. Conclusions: To the best of our knowledge, this is the first study to show a higher lifetime prevalence of manic/hypomanic episodes in a general-population sample of individuals who migrated to a foreign country. Our results are in agreement with the hypothesis that hyperactive/novelty-seeking features may represent an adaptive substrate in certain conditions of social change.
A year has passed, and the COVID-19 pandemic continues to spread around the world. Apart from its direct devastating health consequences, voices have been raised about decreasing mental health. The introduction of social distancing measures and lockdown to prevent the spread of COVID-19 led to a sudden change of routine, a drastic change of the physical and social environment (e.g., reduced social contacts and connection), a change of working conditions and economic losses, all are known to be important drivers for mental health and mental disorders. Evidence from previous studies that have examined the psychological impact of disaster and outbreaks, shows that such health emergencies have its toll on mental health. In Hong-Kong, for example, suicide rates rose sharply during the 2003 SARS epidemic. Given that measures taken during the SARS epidemic interfered much less with normal life and for a shorter period, it is not far-fetched to assume that the COVID-19 pandemic, in one way or another, will affect mental health. In fact, surveys conducted so far, using contemporary data from national surveys, show that since the start of the pandemic, mental health has deteriorated. Current research suggests that poorer mental health is associated with increased fear of illness, social distancing policies and social adversities (e.g. loss of employment), housing conditions as well as loss of support from health and other services. As a consequence of the lockdown and social distancing measures, psychosocial services as well as in- and out-patient mental health care facilities greatly interrupted, reduced and changed their services. Many services switched from face-to-face to digital services and check-in phone calls. However, due to lack of access or ability to use technology and a lack of privacy, remote care is not always considered sufficient. Additionally, people at risk, might feel stigmatized due to the perceptions of being a burden to society. The epidemic may shatter personal goals and way of living and undermine a sense of meaning in life and trust in others. Meaning making, however, is a predictor of resilience and mental health. Resilience is a multidimensional concept which can be defined as being able to adapt to stressful (e.g., family and relationship problems, workplace and financial stressors) and extraordinary threatening events, such as a pandemic. The factors, which contribute to resilience, are manifold, including individual, interpersonal and community factors. At the individual level, very recent research suggests that healthcare personnel, youth and older individuals, and those with a current or past medical history, especially a history of mental illness, are at risk. Additionally, we learnt from other disasters that at the interpersonal level, social isolation, and lack of trusting relationships and at the society level lack of trust in the government might put people at risk. While evidence about the effects of COVID-19 on resilience and mental health is emerging, at this point, no accurate assumptions about the extent of the pandemic on mental health can be made. Furthermore, the mental health responses to the pandemic and the trajectories of mental health and resilience remain unknown. Approaches to mental health and psychiatric care in such outbreaks remain poorly understood, outlined or covered by existing research and there is virtually no substantial knowledge of the mental health impact of rapidly spreading outbreaks of infectious diseases. International cooperation is essential for building appropriate mental health prevention and promotion strategies. Identifying factors that may contribute to better mental health and greater psychological resilience at an international level and sharing experiences and information is of utmost importance. Therefore, a comprehensive assessment of the prevalence, risk and protective factors, of mental health is necessary. For that reasons the international Public Mental Health Section of the European Public Health Association (EUPHA) initiated this study and worked together with the consortium members to set up the Coping with COVID-19 with Resilience (COPERS) study. The consortium includes members of 10 countries all over Europe. COPERS aims to grasp longitudinally the extent of mental health and resilience across Europe, to identify mental health, and resilience trajectories of adults aged 18 years and older and to detect factors that potentially influence mental health and resilience in the different countries. The researchers also aim to conduct a living mapping review to identify, analyze, and present mental health policy responses to the COVID-19 pandemic and contribute to better knowledge on how to support personal and community resilience in times of a pandemic.
