Current situation and challenges for mental health focused on treatment and care in Japan and the Philippines - highlights of the training program by the National Center for Global Health and Medicine.

BACKGROUND AND PURPOSE: Mental health has emerged as an important public health concern in recent years. With a high proportion of children and adolescents affected by mental disorders, it is important to ensure that they are provided with proper care and treatment. With the goal of sharing the activities and good practices on child and adolescent mental health promotion, care, and treatment in Japan and the Philippines, the National Center for Global Health and Medicine conducted a training program on the promotion of mental health focused on treatment and care in Japan and the Philippines in September and November 2019. KEY HIGHLIGHTS: The training program comprised of a series of lectures, site visits, and round table discussions in Japan and the Philippines. The lectures and site visits focused on the current situation of child and adolescent psychiatry, diagnosis of childhood mental disorders, abuse, health financing for mental disorders, pharmacotherapy, psychotherapy, and disaster child psychiatry in both countries. Round table discussions provided an opportunity to explore the similarities and differences between the two countries in terms of the themes discussed during the lectures.The training program identified the need to collaborate with other professionals to improve the diagnosis of mental disorders in children and adolescents and to increase the workforce capable of addressing mental health issues among children and adolescents. It also emphasized the importance of cooperation between government efforts during and after disasters to ensure that affected children and their families are provided with the care and support that they need.

Religious education can contribute to adolescent mental health in school settings.

BACKGROUND: Mental disorders contribute substantial burden to the society due to their widespread occurrence and debilitating effects. A quarter of the world's population are children and adolescents, a significant number of whom experience mental disorders as early as the age of 14. Some interventions have been found to effectively reduce the risk factors and reinforce protective or preventive factors. However, there is still a need to put emphasis on mental health promotion strategies such as religious education. This paper aims to discuss the importance of religious education in promoting mental health. DISCUSSION: Religious education can be instrumental to improving adolescent mental health. Specifically, it can: (1) help develop healthier reaction to stimuli through the internalization of religious morality; (2) reinforce religious coping mechanisms which reduce the impact of stresses, enhance coping skills, and promote a less risky lifestyle; (3) increase awareness regarding religious beliefs and practices and their influence on the individual, the family, and the community; and finally, (4) promote connectedness which can enhance self-esteem and well-being. However, negative health outcomes such as discrimination and social isolation can also develop, especially among religious or gender minority groups. CONCLUSION: It is important to reflect on the crucial role of religious education on adolescent mental health. School-based mental health education and promotion strategies can maximize the benefits of religious education by putting emphasis on effective implementation of religious education to positively influence adolescent mental health.

Suicidal ideation, suicidal behaviors, and attitudes towards suicide of adolescents enrolled in the Alternative Learning System in Manila, Philippines-a mixed methods study.

BACKGROUND: Globally, suicide is a significant cause of death among adolescents. Previous studies conducted in high-income countries suggest that students in alternative schools are more likely to engage in suicidal behaviors than those in formal schools. This study aimed to document suicidal ideation and behaviors among adolescent learners enrolled in the Alternative Learning System (ALS) in Manila, Philippines. METHODS: A mixed methods study was conducted in 24 ALS centers in the city of Manila. ALS centers were stratified according to congressional district and selected using probability proportionate sampling. A cross-sectional survey to determine attitudes towards suicide and prevalence of suicidal ideation and behaviors was administered to 171 learners aged 13 to 17 years old. In-depth interviews with 18 teachers and 12 learners were conducted to explore the school psychosocial environment's role on learners' suicidal ideation and behaviors. Exploratory factor analysis was used to extract attitude factors. Fisher's exact test and Student's t-test were used to identify differences in sociodemographic characteristics and attitudes towards suicide between learners with or without suicidal ideation or behaviors. Qualitative data were analyzed using thematic analysis. RESULTS: Non-specific active thoughts were the most common type of lifetime suicidal ideation (40.9%) while passive ideation was the most common in the past month (13.5%). Aborted suicide attempt was the most frequent behavior in both lifetime (16.4%) and in the past month (4.7%). Non-fatal suicide attempt in the past month was 2.3%, reaching 12.9% for the entire lifetime. Age, sex, education, and attitudes towards suicide were significantly associated with suicidal ideation or behavior. Thematic analysis showed five themes: (1) fostering belongingness, (2) securing learners' safety, (3) teaching philosophy, (4) teacher and learner beliefs towards suicidal behavior, and (5) availability of school-offered and community-based services. CONCLUSION: Suicidal ideation and behaviors are prevalent among adolescent ALS learners. This study also showed a significant difference in attitudes towards suicide and sociodemographic characteristics between learners with and without suicidal ideation behaviors. It also suggests that the school psychosocial environment, through social norms and learner-teacher interactions, can potentially prevent progression of suicidal ideation to behavior, influence help-seeking, and promote mental health among learners.

Addressing challenges in children's mental health in disaster-affected areas in Japan and the Philippines - highlights of the training program by the National Center for Global Health and Medicine.

BACKGROUND AND PURPOSE: Natural disasters such as earthquakes, typhoons, floods, and volcanic eruptions frequently occur in Republic of Philippines and mental health care for children affected by these natural disasters is a major public health concern. Aiming to train health professionals on children's mental health, to conduct a situational analysis to identify the local needs and resources for children's mental health, and to propose a mental health program for children that can be transferred from Japan to the Philippines, the National Center for Global Health and Medicine (NCGM) conducted a training program for children's mental health in disaster-affected areas in Japan and the Philippines in June, October, and December, 2017. The training was organized by NCGM for the Program for International Promotion of Japan's Healthcare Technologies and Services funded by Ministry of Health, Labour, & Welfare, Japan in relation to the Memorandum of Understanding in the Field of Healthcare between NCGM in Japan and University of the Philippines Manila, College of Public Health. KEY HIGHLIGHTS: The training program consisted of classroom trainings, site visits, and round table discussions in Japan and the Philippines. The classroom trainings and site visits focused on two points: the experiences of individuals and families who survived the Great East Japan Earthquake (GEJE) in 2011 and super typhoon Haiyan in 2013 and the program and activities, especially on mental health, of various government and non-government organizations in helping the affected families and communities. The round table discussion, on the other hand, was conducted to identify challenges related to children's mental health in disaster-affected areas and to develop recommendations to address these challenges.The major recommendations for the Philippines were to give equal emphasis to physical and psychosocial preparedness and to develop a comprehensive program to care for carers. In Japan, public health and mental health should be integrated in the Disaster Medical Service. Experts from both countries should also generate evidence on the effectiveness of interventions in reducing mental health stigma and collaborate with school personnel and communities in order to learn more about psychosocial preparedness. Finally, mental health must be mainstreamed in programs not only in Japan but also in other countries. IMPLICATIONS: The training program enabled key stakeholders to describe the current situation of mental health in Japan and the Philippines, to identify mental health challenges common to disaster-affected areas in both countries, and to propose short- and long-term plans and recommendations. The training program is expected to address the mental health needs of children in disaster-affected areas through a responsive community-based support network. The training participants agreed to form a network and build partnerships toward the common goal of mainstreaming community-based support for children's mental health in disaster-affected areas in Japan and the Philippines.

Suicidality among Filipino children and adolescents: a cross-sectional study on substance use among Filipino suicidal and parasuicidal child and adolescent patients

Introduction: The year 2000 World Health Organization reports that the age didtribution of suicide has changed such that the rates for those aged 5-44 years old have increased from 40% to 55%, while those aged 45 and above have decreasing suicide rates of 60% to 45%. In the Philippine General Hospital (PGH), the proportion of child and adolescent suicide cases has increased from 35.8% and 26% in 2003-2004 to 41.7% and 58.4% 2005-2006. To date, local studies on risk factors affecting adolescent suicide have not been done and the number of adolescent attempting to kill themselves in a country known for its close family ties and catholic practices continue to rise. Objectives: To describe the profile of Filipino children who committed suicide or parasuicide and characterize them in terms of history of substance use versus patients without a history of substance use in terms of the following variables: demographics, nature of suicide, and risk factors for suicide. Methods: A retrospective cross-sectional chart review of all Filipino charity patients aged 18 years and below, seen at the PGH Department of Emergency Services (DEMS) from the period January 1, 2006 to October 31, 2007 was done. Data was analyzed using frequency count distribution and ratio and proportion. Results and Conclusions: A total of 56 charts were reviewed for the study. The profile of the Filipino child who attempted suicide in this study can be described as: majority is female, single aged 14-18 years, RC, high school students, and unemployed. Most common method of suicide attempt was through ingestion of silver jewelry cleaner following family conflict. No mortality was reported. Suicide risk factors which appear to be significant in this population are substance use, domestic situation, and involvement in a relationship. Further characterization of the group into those with and without a history of substance use also suggests that increasing age, a lower educational attainment, employment status, family history of suicide, marital status of parents, domestic situation, and involvement in a relationship are factors that may influence substance use among this vulnerable population. Recommendations: Early psychiatric evaluation of alcoholic drinkers among adolescents and parental psycho-education in school should be done to curb the rising incidence of suicide attempts in this vulnerable population. Further, prospective and multicenter studies involving more subjects are needed to validate findings in this study.

Olanzapine IM versus haloperidol IM for acute agitation in schizophrenia

Patients with schizophrenia presenting with agitated or violent behavior require pharmacological tranquilization. Olanzapine is the first atypical antipsychotic to have a short acting intramuscular preparation for control of agitation. There is a need to review the efficacy and safety of olanzapine intramuscular compared to intramuscular haloperidol. Objectives: To compare the efficacy of olanzapine intramuscular with haloperidol intramuscular in controlling acute agitation among patients with schizophrenia. Methodology: The authors searched the Cochrane Schizophrenia Group Register (November 2004), Cochrane Database for studies, Cochrane Controlled Trials Register (Issue 1, 2002), MEDLINE (1992 to the present), Clinical Trials.gov, Lilly Trial Registry and ClinicalTrialresults.org. Authors also hand-searched references of journal articles and contacted pharmaceuticals for relevant literature. Articles included in the meta analysis were randomized clinical trials comparing the efficacy of intramuscular olanzapine to intramuscular haloperidol for controlling agitation among patients with schizophrenia. Included studies had participants 18 years old and above who had schizophrenia and were acutely agitated. Intervention included olanzapine intramuscular 10-20 mgs compared with haloperidol 5-10 mgs. Outcomes included were decreased in agitation as measured by time to tranquility, change in PANSS scale or other appropriate scale and mean dose to achieve tranquility. Secondary outcomes measures were occurrence of adverse events, patient and care giver satisfaction and economic costs. Analysis: Two authors independently assessed the quality of the studies. Data were extracted using the Cochrane Data Extraction Form. Missing data from the studies furnished by ClinicalTrialresults.org. Data that were continuous were sing mean change. Difference in mean change was analyzed using inverse variance, fixed effects method at 95% confidence interval. Data that were dichotomous were analyzed using odds or risk ratio using Mantel-Haenszel method at 95% confidence interval. Results: Pooled data from the studies did not show that olanzapine intramuscular was not equal to haloperidol intramuscular in decreasing acute agitation among patients with schizophrenia. In terms of treatment emergent adverse events, the risk for treatment emergent adverse events was more for haloperidol IM compared olanzapine IM. Conclusions: It cannot be said that olanzapine IM and haloperidol IM are not equal in decreasing agitation among patients with schizophrenia. In terms of treatment emergent adverse events, the risk for extrapyramidal side effects and dystonia was more for haloperidal IM compared to olanzapine IM while the risk for abnormal blood pressure was more for olanzapine IM compared to haloperidol IM. There is need to assess other factors like economic cost, patient and caregiver satisfaction which the studies in this meta-analysis did not include.

Asian outpatients with schizophrenia: a double-blind randomized comparison of quality of life and clinical outcomes for patients treated with olanzapine or haloperidol.

To examine the quality of life (QoL) and clinical outcomes for Asian schizophrenic outpatients treated with olanzapine or haloperidol. Patients were randomized to 24-weeks' treatment with either olanzapine (n = 144) or haloperidol (n = 132) in a double-blind, prospective, multi-country study. The QLS and WHO-BREF were assessed for QoL; the PANSS, BPRS and CGI scales for clinical status; the BAS, AIMS and SAS scales for physical dysfunction. Regardless of antipsychotic, QoL improved significantly at 8 weeks and maintained this improvement at 24 weeks. Compared with haloperidol, olanzapine treatment was associated with significantly better QoL in the WHO-BREF physical and social relationship domains, better improvements in extrapyramidal symptoms in BAS and SAS scores, as well as lower incidence of adverse events. Patients taking haloperidol were more likely to be co-prescribed anticholinergics. The comparatively superior side-effect profile and tolerability of olanzapine may have contributed to enhance domain-specific QoL for these Asian outpatients.

Assessment of the knowledge and attitudes of parents of mentally retarded children enrolled from special education at Sta. Ana Elementary School

The objective of this study is to determine the level of knowledge about mental retardation and attitudes of parents towards their mentally retarded child enrolled for especially education in Sta. Ana Elementary School. The parents who responded to this survey were mostly mothers belonging to the 41-65 age group, married, unemployed, high school graduates earning less than Php 5,000.00 a month, and Roman Catholic. Majority of the respondents had low or poor level of knowledge regarding mental retardation.