Sense-of-place (as rootedness), social capital (as trust), job control, age, spirituality and number of childhood disorders shaped mentalhealth in OOMs only. Most of the predictors of a strong sense-of-place are characteris- tic of OOMs and non-OOMs alike (e.g., lengthy resi- dence, home ownership, low density housing). Lack of ethnic diversity in the closed OOM community may ac- count for their stronger sense-of-place . Generational experiences, dating back to the early 1800’s for Waterloo OOMs, may result in their stronger sense-of-place by reinforcing individual and group continuity [28,29]. Tӧn- nies considered place (land) as one of the three pillars (bonds) of Gemeinschaft [98,99], thus sense-of-place may be an organic element of OOM culture. Sense-of- place may also arise from the sense of security deeply characteristic of communal societies . However, a strong sense-of-place does not necessarily produce better health [27,100]. Recent studies suggest that it may be important to focus on rural populations and/or mentalhealth [23,30], although rurality alone has been linked to a strong sense-of-place in many but not all studies [29, 101]. While little is known about the mechanisms linking sense-of-place with health, the psychosocial pathway seems to be a plausible mechanism. Chronic exposure to stressors can lead to elevated blood cortisol levels which have been linked to major chronic conditions such as de- pression, cardiovascular disease, and diabetes . Strong sense-of-place in OOMs could reflect their low stress levels, which could translate into positive physiological changes affecting health. Also, since sense-of-place in OOMs is more socially than physically oriented, it may reflect high levels of social interaction/support or other elements of social capital, which in turn may be linked to positive health outcomes. Reduced stress and increased social interaction were viewed as the most probable path- ways linking trust with health in a recent study .
The research questions the study explored were 1) What effect do CTOs have on ethnic minority individ- uals and how do these individuals perceive the treat- ment? and 2) How are CTOs experienced in comparison with other experiences in the mentalhealth system? Phenomenology was used as a conceptual framework best suited to effectively explore these questions because the objective of the study is to explore the lived experi- ence of the participants from their perspective and understand the meanings they constructed from it. As Creswell  asserts, a phenomenological study “describes the meaning of the lived experiences for several individ- uals about a concept or phenomenon” (p.76). More than a conceptual framework, however, phenomenology is also a methodological approach that probes the human experi- ence, shedding light on the complexity of individual perceptions and offering ways of gaining insight and understanding into people’s experiences. This will be described in subsequent sections.
Rosenheck found respondents with fair or poor SRMH were older, less likely to have a high school education, and had more self-reported mental or physical condi- tions . In 2000, O’Donell examined SRMH among veterans and non-veterans and found lower SRMH for the latter but this group difference was eliminated on controlling for demographic, socioeconomic, and health- related factors . In 2005, Cohen and Patten found a gender effect among Alberta medical residents; more males reported excellent SRMH than female residents. Overall 17% of residents reported fair or poor SRMH compared to 8% in national communityhealth survey . In 2006, Shields found that low satisfaction with job was related to fair or poor SRMH . In 2008, Zuvekas and Flieshman found poorer SRMH among those who had a lower income, were less educated, female, or aged 41–60 . In 2010, De Castro examined NLAAS data finding that employment frustration was associated with low SRMH even after controlling for gender, age, ethnicity, education, occupation, income, whether immigrated for employment, years in the United States, English proficiency, and a gen- eral measure for everyday discrimination . In 2010, Maximova et al. examined resettlement experiences of Canadian refugees and found that having employment and access to settlement services were associated with improve- ments in SRMH while time spent in a refugee camp and having held a professional job in home country were asso- ciated with a decline in SRMH .
Everything was self-sufficient here. Every family has farmland. The husband has to work in the field during the day too. They raise fruits such as strawberries and blueberries, and other crops. They make maple syrup, and raise chicken, pigs, and cows. Bread and butter are all self-made. They eat things like vegetable stew and pork stew, mostly German style. Alcohol is only used during religious rituals. They burn wood for cooking. Electricity and gas are basically forbidden and they live a life of waking up together with the sunrise and going to sleep when the sun sets. However, more recently their lifestyle has started to change. There have emerged families who started using electricity, and also some families who started using tractors for farming. Among the most progressive are the Mennonites in the village of the Amish in the state of Penn in the United, who were the earliest Mennonite settlers in the North America. I have heard that they welcome visitors, and even have restaurants and gift shops for tourists. How are the Canadian Mennonites feeling about the introduction of modern technology? “I know they exist, but I do not think they are necessary for our lives.” With a reserved tone, they just reply in this way, indeed like a pacifist. 7 As we can see above, this magazine article was written in order to introduce its Japanese readers to some basic and reliable knowledge about the OldOrderMennonite people. It emphasizes the authenticity and the reliability of the content by highlighting the
Access was secured to six National Health Service (NHS) organisations providing mentalhealth care: four Trusts in England (pseudonymously referred to as ‘ Artois’ , ‘Dauphine’ , ‘Languedoc’ and ‘Provence’) and two Local Health Boards (LHBs) in Wales (‘Burgundy’ and ‘Champagne’). Sites were selected to reflect geograph- ical, population and urban/rural diversity (see Table 1). With help from local collaborators and research sup- port staff, access was secured to 20 communitymentalhealth teams (CMHTs) across the six sites, with one specific team within each of these sites identified for in-depth case studies. In the UK CMHTs are the main vehicles for the local provision of secondary mentalhealth care, and are typically funded by NHS and local authority organisations and staffed by health and social care workers, including psychiatrists, mentalhealth nurses, occupational therapists, psychologists and so- cial workers. Sampling criteria for CMHTs included the routine provision of care to adults, having a team manager in post and not being scheduled for merger or closure.
We trained each group for 14 days respectively, the new curriculum for the new model group, while the old one for the traditional model group. In the new curriculum training, we combine the public and clinical knowledge to set curriculum which used the WHO mhGAP Interven- tion Guide and the Chinese Medical Association’s guide- lines (for the prevention and treatment of schizophrenia and bipolar disorder, etc.) and used a needs-based ap- proach in supervision; while the traditional courses and supervision were used for the traditional model group [17–19]. After 6 months and 12 months, we evaluated the subjects, and compared the results with baseline survey data. Details are shown in Fig. 1.
These results of high burden of mentalhealth diagno- ses among women in sex work and its linkages to vari- ous forms of trauma underscore an urgent need to further explore trauma-informed care and practice, in- cluding clinical training and system wide policies that adopt resiliency perspectives and address intersections between historical colonization, stigma/discrimination, policing, and substance use [52, 53, 66]. An existing model that is pioneering peer-based mentalhealth treat- ment paired with advocacy and physical and sexual health care is the St. James Infirmary in San Francisco, California. Research from this organization shows that many sex workers fear stigma from health care pro- viders, and as such interventions offering peer support, safe spaces, and collective organizing capacity remain critical for successfully achieving improved health and social outcomes for sex workers . Further studies are also warranted to better understand and address the di- verse mental illness experiences and needs of women in sex work who are operating across a range of work envi- ronments and urban settings. Community-based and mixed-methods approaches which explore relationships between structural, historical, individual and interpersonal factors are necessary to inform tailored, trauma-informed interventions that better address the complex and overlap- ping correlates of depression, PTSD, and anxiety.
The CPT intervention was provided using an appren- ticeship model for training and supervision. The CMHWs received seven days of in-person training with expert US- based CPT trainers (DLK, KPL) based on a manual that was translated and adapted for the Southern Iraq context. Ongoing supervision was provided through a multi-tiered supervision structure: An Iraqi psychiatrist and cognitive psychologist provided direct supervision through phone or in person meetings with the CMHWs; a bilingual US- trained physician trained in CPT (GZ) provided telephone and Skype oversight and supervision to the supervisors; and this physician communicated with the US-based experts (DLK, KPL) through weekly calls for additional support and quality assurance. Cultural adaptations, de- scribed elsewhere, were made to the standard CPT treatment so as to accommodate cultural differences, better meet the needs of clients with lower levels of education, and to be easier for therapists with less training in mentalhealth interventions to administer . Participants in the intervention group attended in- dividual therapy sessions with CMHWs. Therapy was 12 sessions, usually 1 week apart.
Commission of Canada, 2012), a large portion of the workforce is struggling to overcome these concerns, which has an impact on not only the individual’s well-being but also their abilities to work (e.g., work quality, productivity, days sick etc.; Smetanin et al., 2011). In the education sector, teachers are of utmost importance as their job performance and stress level has a direct impact on student achievement and student well-being (Arens & Morin, 2016). Unfortunately, teachers regularly experience high levels of stress, emotional exhaustion and mentalhealth symptoms which places them at risk for occupational burnout (Martin et al., 2012). In order to reduce these symptoms and improve teacher well-being, research such as this study point to building up emotional intelligence competencies in teachers. In fact, this research provides compelling evidence for a strong relationship between emotional intelligence (EI) and mentalhealth in Canadian teachers and suggests that targeted interventions focusing on the EI factor Well-being is a promising route to improve teacher mentalhealth overall. This research not only highlights a necessity to support teachers but also why it is important to teach teachers the appropriate EI skills and provide ongoing support. Applying these findings to real life
However, the use of CTO might not have been the only factor which drove this increased frequency of con- tact. The results from our two methods of analysing this cohort are conflicting and both of our methods have limitations. The randomised groups suffered from a large number of crossovers, with 43.2% of the non-CTO arm made subject to CTO during the 3 year follow-up, whilst analysing by exposure to CTO introduced selection bias. Those with any exposure to CTO (independent of ran- domisation) had significantly more readmissions than those without CTO exposure. Patients who are admitted to hospital often have increases in community follow-up prior to admission and following discharge and the associ- ations we found may have been driven by this different clinical pathway. A previous study of ours found that con- tact frequency was significantly associated with admissions . Furthermore, the frequency of contact between a pa- tient and community team is also likely to be influenced by a number of factors including severity of illness, perceived need, and availability of resources. It is also possible that following an admission, patients were placed on a CTO and this drove the increase in con- tact that we measured.
The Cancer Risk Management Model (CRMM) is a spin-off model from POHEM developed by Statistics Canada in collaboration with CPAC to assess cancer control strategies in the areas of prevention, screening, and treatment for four major cancer sites: lung, colorectal, cervical and breast [23, 24]. They feature sophisticated natural history models of tumor onset and progression. Evans et al. projected estimates of future lung cancer inci- dence with current smoking rates holding steady (approxi- mately 22 %) and counterfactually with smoking rates decreasing by 50 % over 3 years . The CRMM lung module can also be used to compare the cost-effectiveness of similar smoking cessation initiatives to alternative inter- ventions, including introduction of new screening pro- grams, for instance, low dose CT scanning to detect early lung cancer [23, 24, 35]. The CRMM colorectal model has been used to evaluate different screening modalities (fecal occult blood, fecal immunological test, sigmoidoscopy and colonoscopy) under a range of program characteristics (age range, frequency, participation rates, costs) at a provincial level, as well as to assess the potential cost- effectiveness and budgetary impacts of implementation . The CRMM cervical model can be used to evaluate the potential reorganization of cervical cancer screening in the context of vaccination for human papillomavirus (HPV) and HPV DNA testing. A wide range of scenarios have been evaluated to inform the Canadian Cervical Cancer Screening Network. This example illustrates the power of microsimulation to evaluate multiple interven- tion strategies including prevention, screening, and treat- ment, and provides common metrics with which to compare them. CRMM has also been made available on the web for easy use by cancer control and health policy analysts, who can use it to evaluate different cancer control strategies [23, 24].
Ipum (epilepsy), also referred to by participants as fall- ing sickness (adeka na ebironor), repeated fits or attacks (adoenen aria ebironor na ebongonikini), and fainting (ailonor), was prioritized as the second most important perinatal mentalhealth concern. Epilepsy is not a highly prevalent disorder in eastern Africa; a meta-analysis esti- mated its prevalence as 5.1 per 1000 people, though given the stigma associated with epilepsy, this may be an underestimation . However, compared to other re- gions, epilepsy is about twice as common in sub-Saharan Africa , and an analysis of primary care health infor- mation system data found that it is the most common presenting mental, neurological, or substance use related complaint in refugee settings . Given that partici- pants in this study indicated that conflict, stress, and evil spirits may cause ipum, its high prioritization may be in part due to an overlap with non-epileptic fits in the con- text of spirit possession. Previous research in southern Uganda has found that dissociative complaints, which are linked to the experience of potentially traumatic events, may include fits [43, 44].
By the end of 2016, the total number of active patients (that is patients regularly attended scheduled follow‑up appointments) was 293 (mean age 63 years). Almost half of them (49.5%) were older adults, with a mean age of 77.5 years and a total of 29.7% of the patients being ≥75 years old. Most common diagnoses are affective disorders and psychotic disorders [Table 1]. Moreover, 70 additional patients were rated as “partially engaged,” that is they do not attend follow‑up appointments regularly, but they still visit our service sometimes. Each of the team members has a high caseload (mean 36.6 patients). A significant proportion of patients (n = 82, 28%) receive care with regular domiciliary visits.
Results: The overall Fleiss’ kappa, the measure of inter-rater reliability for this sample of tri- age nurses (n=18), was 0.312, representing only fair albeit statistically significant (P,0.0001) agreement. Kendall’s coefficient of concordance for the sample was calculated to be 0.680 (P,0.0001), which signifies moderate agreement. Although the sample reported high levels of education, comfort with mentalhealth presentations, and experience, accuracy in urgency rat- ings measured by the percentage of correct responses ranged from 0.05% to 94% (mean: 54%). Greater accuracy in urgency ratings was recorded for triage nurses who used second-order modifiers and avoided the use of override.
It is important to identify the socioeconomic profile of the participants in this study in order to be able to understand the applicability of these results to various other situations. Fifteen participants completed at least a post-secondary diploma or degree, with many completing post- graduate degrees (n=8), meaning that 23 out of 28 participants completed higher education. Most of the latter came from the healthy groups, with only a single participant from the older at-risk group having a post-graduate degree. Most participants declined to provide their annual household income, but there are few facts worth reporting here. The highest reported incomes corresponded with the healthy groups (1 individual in H50 reported over $200,000/year; 2 individuals in H71 reported over $100,000/year. Only two participants in R50 reported annual income: $50,000 and $80,000 per year. No R71 participants reported their income. Two participants from the MCI group reported annual income: $50,000 and $60,000 per year. The overwhelming majority of the participants were of Caucasian descent and were born in Canada. Out of those not born in Canada, all but one are of Caucasian European descent. The remaining participant is from Sri Lanka. Those born outside of Canada spent the majority of their lives living in Canada, and all but three have English as their first language, though the remaining three are fluent English speakers.
questionnaires was 1344 or 39.3% of the total population surveyed. Response rates by province/territory ranged from 19% (Northwest Territories) to 74% (Nunavut). Study participants were 94.5% female. Their mean age was 49.2 years (SD = 9.7). The majority of nurses were RNs (82.2%), while 15.5% were either RN (EC) or NPs. The highest level of education attained in nursing was a Doctorate (0.1%), Masters degree (4.6%), however, the majority of nurses held a diploma (39.5%) or Baccalaur- eate degree (53.5%) in nursing. A small group identified having a certificate (2.3%) as their highest level however we were unable to determine what types of certificates these were. Almost half (47.5%) were employed in nurs- ing for over 25 years, while 26.4% worked for 16-25 years. The largest group (21.4%) worked specifically in the community for 6-10 years, while 12.8% of nurses did so for more than 25 years. Most nurses indicated that they worked in a public health unit/department (22.7%) or in a public or private home health agency (23.5%). Other workplaces included primary care set- tings such as a physician’s office or a communityhealth centre (18.5%), communityhealth agency (9.9%), and mentalhealth centres (4.7%). The most common posi- tions based on primary employers were public health nurses (21.2%) followed by home health nurses (14.1%).
The Leeds Attitude toward Concordance scale (LATCon) is a 12-item self-report scale, developed by Raynor et al.  and validated into Spanish by De las Cuevas et al.  that assessed patients’ and health professionals’ atti- tudes towards concordance in medicine-taking. The res- pondent scores each item on a four point Likert scale: strongly disagree (0), disagree (1), agree (2) or strongly agree (3). The total maximum score is therefore 36. The higher the score in the scale, the more positive the res- pondent’s attitude towards concordance. To facilitate interpretation, the total score is divided by the number of items leading to an average score per item. A mean item score of between 2 and 3 indicates that the respondent tends to “agree” with the concept of concordance, while an average score below 2 suggests that he/she does not do so. In order to specifically assess the agreement in a psychiatric context, the term “doctor” was replaced by “psychiatrist”.
interpreted as the patient ’ s idea of health or illness (for example, the pills are taken when one is sick and not when one is well); Factors 4 and 5 include items that express the patient ’ s attitude regarding the control of therapy intake; Factor 6 consists of two items formulated to indicate what the patient believes on drug ef ﬁ cacy to prevent relapses; Factor 7 concerns potential toxic effects. The sum of the items of these last ﬁ ve factors identi ﬁ es a construct called the “ attitude towards ther- apy ” . As reported in the work of the authors of the questionnaire, Hogan et al, 44 the DAI-30 can therefore be divided into two sub-scales, one of the 14 items and the other of 11. The remaining 5 items are omitted from the evaluation. The ﬁ rst sub-scale, which includes Factors 1 and 2, evaluates the “ subjective response to treatment ” ; the second, which includes the remaining ﬁ ve factors, assesses the “ attitude towards therapy ” .
These findings further support the perspective of au- thors [43,44,45] who argue that adolescents’ negative attitudes towards individuals with mental disorders may be amenable to change through educational program- ming related to mental illness and that this may lead to improved attitudes and increased access of mentalhealth care by youth [46,47]. This approach, applied in this study, differs markedly from commonly employed stand- alone stigma reduction programs, which have not been extensively shown to decrease stigmatizing attitudes in adolescents [48,49]. In this study, the use of a school- based curriculum delivered by usual classroom teachers based on The Guide, demonstrated significant reduction in stigmatizing attitudes following implementation, and although attitude scores decreased somewhat over time, they still remained higher than at baseline. This suggests that embedding mentalhealth literacy into usual school curriculum may be an effective and sustained anti- stigma approach for young people.
In the same vein, about two-thirds of the elders seen at this service point with mentalhealth needs were fe- males and those with tertiary-level education consti- tuted the largest proportion of the elders attended to within the period of this review. These findings but- tressed previous observations that women and those with education may take health issues more seriously as well as readily present for health care in this setting irrespective of the age (6,17). Again, elders that be- longed to the lower social economic class were over- represented among those seen in this public mentalhealth facility. While this finding may indirectly re- flect the association previously shown between low social economic class as well as its attendant psycho- social stressors and mentalhealth problems (14,18); it is also explainable by other reasons because research- ers have fielded contradictory finding (19). Some of the plausible reasons include the study center being a public hospital, and may be more affordable for old and retired people with diminished earning power, especially because social security programs are virtu- ally lacking.