Help-seeking behaviour in women diagnosed with gynaecological cancer: a systematic review.

BACKGROUND: Identifying what prompts or hinders women's help-seeking behaviour is essential to ensure timely diagnosis and management of gynaecological cancers. AIM: To understand the factors that influence the help- seeking behaviour of women diagnosed with gynaecological cancer. DESIGN AND SETTING: Systematic review and narrative synthesis of studies from high-income settings worldwide. METHOD: Five databases were searched for studies, of any design, that presented factors related to the help-seeking behaviour of women diagnosed with a gynaecological cancer. Data from the articles were extracted and presented using narrative synthesis, which was both inductive and deductive. The COM-B (capability, opportunity, motivation, behaviour) model of behaviour change was used as a framework. RESULTS: In total, 21 studies were included in the review. Inductive synthesis presented three main themes of factors related to the help-seeking behaviour of women diagnosed with gynaecological cancer: patient factors, such as knowledge of symptoms; emotional factors, including previous healthcare experience, embarrassment, and trust; and practical factors, including time and resources. Deductive synthesis demonstrated that capability (namely, symptom knowledge), opportunity (having the required time and overcoming the cultural taboos surrounding gynaecological symptoms), and motivation (believing that seeking help is beneficial) are all required to initiate help-seeking behaviour. CONCLUSION: Although it is a journey of defined steps, the help- seeking behaviour of women with symptoms diagnosed with gynaecological cancer is influenced by personal and societal factors. Interventions to improve help seeking will need to address the specific identified factors, as well as capability, opportunity, and motivation.

Help-seeking attitudes and behaviours for mental health problems in adolescents before and during the first COVID-19 school closures in Germany.

AIM: Comparing measures of psychological wellbeing and help-seeking in youths before and within the first school closures due to the coronavirus disease 2019 (COVID-19) pandemic enables a better understanding of the effects the pandemic has for those seeking professional help for mental health problems. METHODS: Data were obtained from the Germany-based ProHEAD school study. Pre-lockdown and lockdown samples (n = 648) were compared regarding pupils' psychological wellbeing, help-seeking attitudes and help-seeking behaviour. RESULTS: Participants from the lockdown sample showed greater positive attitudes towards seeking professional help, whereas psychological wellbeing and help-seeking behaviour remained stable. CONCLUSIONS: Possible explanations may include an increased public discourse on mental health or self-selection bias for participation during lockdown.

An online community peer support intervention to promote COVID-19 vaccine information among essential workers: a randomized trial.

INTRODUCTION: Vaccine hesitancy is still rampant in the United States, including health care personnel. Vaccination of frontline essential workers (e.g. health care workers) is very important, especially during a pandemic. We tested the efficacy of a 4-week online, peer-led intervention (Harnessing Online Peer Education) to promote requests for COVID-19 vaccine information among essential workers. METHODS: Participants (N = 120) and peer leaders (N = 12) were recruited through online advertisements from July 23 to August 20, 2021. Eligibility criteria included: 18 years or older, U.S. resident, English speaker, part of phase 1a or 1 b of COVID-19 vaccine rollout (e.g. frontline essential workers), hadn't received a COVID-19 vaccine but able to receive one. This was a parallel assignment randomised trial. STATA was used to create a randomisation using a random number generator so that all possible assignments of participants and peer leaders to groups were equally likely. Participants were randomly assigned to intervention or control arms that consisted of two private, hidden Facebook groups, each with 30 participants. Peer leaders were randomly assigned to an intervention group, each with six peer leaders. Participants in the intervention arm were randomly assigned to three peer leaders. Participants were blinded after assignment. Peer leaders were tasked with reaching out to their assigned participants at least three times each week. Participants completed a baseline and a post intervention survey. The study is registered on ClinicalTrials.org under identifier NCT04376515 and is no longer recruiting. This work was supported by the NIAID under grant 5R01AI132030-05. RESULTS: A total of 101 participants analysed (50 intervention and 51 control). Six people in the intervention group and 0 people in the control group requested vaccine information. Ten people in the intervention group and six people in the control group provided proof of vaccination. The odds of requesting vaccine information in the intervention group was 13 times that in the control group (95% confidence interval: (1.5, 1772), p-value = 0.015). Thirty-seven participants in the intervention group and 31 in the control group were engaged at some point during the study. CONCLUSIONS: Results suggest peer-led online community groups may help to disseminate health information, aid public health efforts, and combat vaccine hesitancy. Key MessagesThe odds of requesting vaccine information was 13 times in the intervention group.Peer-led online communities may help to disseminate information and aid public health efforts to combat vaccine hesitancy.

What are the barriers and facilitators to seeking help for mental health in NHS doctors: a systematic review and qualitative study.

BACKGROUND: The mental health of healthcare professionals is reaching a breaking point, and the COVID-19 pandemic has exacerbated current mental health issues to unprecedented levels. Whilst some research has been carried out on the barriers that doctors face when seeking mental health help, there is little research into factors which may facilitate seeking help. We aimed to expand the research base on factors which act as barriers to seeking help, as well as gain insight into facilitators of help-seeking behaviour for mental health in NHS doctors. METHODS: We conducted a systematic literature review which identified the barriers and facilitators to seeking help for mental health in healthcare professionals. Following this, we conducted semi-structured interviews with 31 NHS doctors about their experiences with mental health services. Finally, through thematic analysis, key themes were synthesised from the data. RESULTS: Our systematic literature review uncovered barriers and facilitators from pre-existing literature, of which the barriers were: preventing actions, self-stigma, perceived stigma, costs of seeking treatment, lack of awareness and availability of support, negative career implications, confidentiality concerns and a lack of time to seek help. Only two facilitators were found in the pre-existing literature, a positive work environment and availability of support services. Our qualitative study uncovered additional barriers and facilitators, of which the identified barriers include: a negative workplace culture, lack of openness, expectations of doctors and generational differences. The facilitators include positive views about mental health, external confidential service, better patient outcomes, protected time, greater awareness and accessibility, open culture and supportive supervisors. CONCLUSION: Our study began by identifying barriers and facilitators to seeking mental health help in healthcare workers, through our systematic literature review. We contributed to these findings by identifying themes in qualitative data.. Our findings are crucial to identify factors preventing NHS doctors from seeking help for their mental health so that more can be done on a national, trust-wide and personal level to overcome these barriers. Likewise, further research into facilitators is key to encourage doctors to reach out and seek help for their mental health.

Nurse admissions at a specialized mental health programme: A pre-Covid-19 retrospective review (2000-2019).

AIMS: Nursing is a stressful and emotionally demanding profession. To date, few mental health treatment interventions have been developed for them worldwide. This study aims to explore referral trends in nurses with mental disorders admitted to a pioneer specialized mental health programme in Europe from 2000 to 2019. DESIGN: A retrospective observational study of 1297 medical e-records of nurses with mental health disorders admitted to the Galatea Care Programme in Barcelona was conducted. METHODS: Three periods were analysed: 2000-2006, 2007-2012 and 2013-2019. Socio-demographic and clinical variables were compared. Diagnoses followed Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria. RESULTS: Gender and age at referral did not change over time. Self-referrals grew from 85.1% in the first period to 95.3% in the last period; inpatient admissions decreased from 24.1% to 18.2%, although this was not significant; nurses were less frequently on sick leave on admission over time (59.1% vs. 45.7%); they were more likely to have a temporary contract in the second period (9.5% vs. 4.8% and 4%) and prevalence of main diagnosis changed with a considerable decrease in affective and substance use disorders after 2006 and a progressive increase in adjustment disorders during the whole period. CONCLUSION: Free, voluntary, highly confidential programmes for nurses with mental disorders may enhance voluntary and earlier help seeking. These findings can be considered when implementing specialized interventions for them in other settings. WHAT PROBLEM DID THE STUDY ADDRESS?: Nursing is a stressful and emotionally demanding profession. To date, few specialized mental health services have been developed for them worldwide. This study aims to explore referral trends in nurses with mental disorders admitted to a pioneer programme in Europe, the Galatea Care Programme in Barcelona, from 2000 to 2019. WHAT WERE THE MAIN FINDINGS?: The number of referrals to the programme grew especially after the first 7-year period. Admissions were more likely to be voluntary during the last period. Prevalence of substance use disorders at admission dropped steadily while prevalence of adjustment disorders progressively increased over the two decades. Nurses were also less likely to be on sick leave at admission. WHERE AND ON WHOM WILL THE RESEARCH HAVE IMPACT?: Free, voluntary, highly confidential programmes for nurses with mental disorders may enhance voluntary and earlier help seeking. These findings can be considered when implementing specialized interventions for them in other settings.

How can the utilisation of help for mental disorders be improved? A quasi-experimental online study on the changeability of stigmatising attitudes and intermediate variables in the process of utilisation.

BACKGROUND: Epidemiological studies show that even in highly developed countries many people with depression do not seek help for their mental health issues, despite promising prevention approaches encouraging people to seek help and reduce self-stigma. Therefore, an anti-stigma intervention study to support help-seeking behaviour will be developed on the basis of the newly explicated "Seeking Mental Health Care Model". METHODS: A quasi-experimental online study will be carried out to assess the effect of different intervention variables relevant for the help-seeking process. The study is conceived as a fractional factorial design. Participants will be screened for depressive complaints (PHQ-9 sum score ≥ 8) and current psychiatric/psychotherapeutic treatment. After baseline assessment the participants will be randomly allocated into one of the 24 study groups receiving different combinations of the vignette-based intervention aiming to reduce stigma and support help-seeking. Next, relevant outcome measures will be administered a second time. In a 3- and 6-month follow-up help-seeking behaviour will be measured. Gamified elements and avatar-choice techniques will be used to heighten study immersion and adherence. DISCUSSION: On the basis of the project results, promising research and intervention perspectives can be developed. Results, firstly, allow for a more detailed empirical investigation and conceptualisation of the stages of mental health care utilisation, as well as an examination of theoretical approaches to stigmatisation. Secondly, our online study could provide insights for an evidence-based design and evaluation of online interventions for people with a mental illness. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00023557 . Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111-1264-9954. Registered 16 February 2021.

Depression and anxiety in healthcare professionals during the COVID-19 pandemic.

Healthcare staff have been at the centre of the fight against the COVID-19 pandemic, facing diverse work-related stressors. Building upon studies from various countries, we aimed to investigate (1) the prevalence of various work-related stressors among healthcare professionals in Germany specific to the COVID-19 pandemic, (2) the psychological effects of these stressors in terms of clinical symptoms, and (3) the healthcare professionals' help-seeking behaviour. To this end, N = 300 healthcare professionals completed an online survey including the ICD-10 Symptom Rating checklist (ISR), event-sampling questions on pandemic-related stressors and self-formulated questions on help-seeking behaviour. Participants were recruited between 22 May and 22 July 2020. Findings were analysed using t tests, regressions and comparisons to large clinical and non-clinical samples assessed before and during the pandemic. Results show that healthcare professionals were most affected by protective measures at their workplace and changes in work procedures. Psychological symptoms, particularly anxiety and depression, were significantly more severe than in a non-clinical pre-pandemic sample and in the general population during the pandemic. At the same time, most professionals indicated that they would not seek help for psychological concerns. These findings indicate that healthcare employers need to pay greater attention to the mental health of their staff.

An Exploration of the help-seeking experiences of patients in an allied professions-led rapid access chest pain pathway: a qualitative study.

OBJECTIVE: A number of studies have explored delayed help-seeking practices for acute coronary syndrome (ACS) and have indentified multiple intersecting factors which may play a role, for example, attributing symptoms, age, gender, ethnicity and contextual influences. However, the pathway to diagnosis for suspected coronary heart disease (CHD) symptoms in a rapid access chest pain clinic (RACPC) context is underexplored. The objective of this study was to examine patients' help-seeking experiences of accessing RACPC services, from the point at which they notice and interpret symptoms, to their decision to seek help from their general practitioner. DESIGN: Qualitative study. SETTING: Interviews were conducted in the RACPC at Queen Mary's Roehampton Hospital, London, UK. PARTICIPANTS: Maximum variation sampling was used to recruit 30 participants (15 men and 15 women) referred to a RACPC, using sampling dimensions of age, ethnicity and occupation. METHODS: Semi-structured interviews focussed on the patient experience of their pathway to the RACPC. Thematic analysis was used to analyse the interview data. RESULTS: Participant interpretation of symptoms was shaped by multiple influences; reluctance to seek help contributed to delay; various factors acted as drivers as well as barriers to help-seeking; and GP referrals to RACPC were based on symptoms as well as patients' need for reassurance. CONCLUSION: We found complex issues shaped the patient's decision-making when accessing the RACPC, including making sense of symptoms and help-seeking practices. These findings can be used to develop health promotion literature to encourage early help-seeking and improve RACPC services.

Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care.

BACKGROUND: The COVID-19 pandemic has impacted the psychological health and health service utilisation of older adults with multimorbidity, who are particularly vulnerable. AIM: To describe changes in loneliness, mental health problems, and attendance to scheduled medical care before and after the onset of the COVID-19 pandemic. DESIGN AND SETTING: Telephone survey on a pre-existing cohort of older adults with multimorbidity in primary care. METHOD: Mental health and health service utilisation outcomes were compared with the outcomes before the onset of the COVID-19 outbreak in Hong Kong using paired t-tests, Wilcoxon's signed-rank test, and McNemar's test. Loneliness was measured by the De Jong Gierveld Loneliness Scale. The secondary outcomes (anxiety, depression, and insomnia) were measured by the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder tool, and the Insomnia Severity Index. Appointments attendance data were extracted from a computerised medical record system. Sociodemographic factors associated with outcome changes were examined by linear regression and generalised estimating equations. RESULTS: Data were collected from 583 older (≥60 years) adults. There were significant increases in loneliness, anxiety, and insomnia, after the onset of the COVID-19 outbreak. Missed medical appointments over a 3-month period increased from 16.5% 1 year ago to 22.0% after the onset of the outbreak. In adjusted analysis, being female, living alone, and having >4 chronic conditions were independently associated with increased loneliness. Females were more likely to have increased anxiety and insomnia. CONCLUSION: Psychosocial health of older patients with multimorbidity markedly deteriorated and missed medical appointments substantially increased after the COVID-19 outbreak.