Pharmacy students' experiences in provision of community pharmacy mental health services.

BACKGROUND: Little information is available describing the pharmacy student's experience working in community practice with people with lived experience of mental illness. Students' perspectives as observers, learners, technical staff and future pharmacists are important. OBJECTIVE: To gain a better understanding of the pharmacy student experience in community pharmacy-based service provision to people with lived experience of mental illness. METHODS: We conducted a qualitative study using interpretive description and application of the Theoretical Domains Framework. Focus groups were held with third- and fourth-year undergraduate pharmacy students from one Canadian university. RESULTS: Two student focus groups were held in the fall of 2012 with 11 students (7 third year and 4 fourth year), 6 women and 5 men, mean age 24.5 (range, 21 to 30) years, averaging 3.2 years (range, 2 weeks to 7 years) of cumulative, mostly part-time, community pharmacy experience. Three broad themes emerged from the pharmacy student experience: (1) business tension; (2) roles, responsibilities and relationships; and (3) stigma. Students discussed their own roles, responsibilities and relationships in a pluralistic identity experience (i.e., pharmacy student, technician, future pharmacist). Application of the Theoretical Domains Framework demonstrated numerous influences on behaviour. CONCLUSIONS: From the students' description of community pharmacy-based care of people with lived experience of mental illness, significant issues exist with current practices and behaviours. Advancing the role of pharmacists and pharmacy students to meet the needs of people with mental illness will require strategies to address multifactorial influences on behaviour.

Post-suicide intervention programs: a systematic review.

OBJECTIVE: The purposes of this study were: 1) to determine the effectiveness of suicide postvention programs on suicide attempts and suicide as well as grief symptoms, mental distress, and mental health broadly defined; and 2) to investigate their cost-effectiveness. METHODS: Computerized database searches (PubMed, PsycINFO, Cinahl, Cochrane Database, Crisis and Suicide & Life-Threatening Behavior) were performed in September 2009 to obtain evaluations of suicide postvention programs and in February 2010 (Centre for Research and Dissemination Database, Cochrane Database of Systematic Reviews, PubMed, PsycINFO, and Cinahl) to obtain cost-effectiveness analyses of bereavement programs. Hand searches of relevant articles and reviews were also conducted. Publications were included in the analysis if they described an evaluation/cost-effectiveness analysis of a suicide postvention program, provided data, and were published in English-language peer-reviewed journals. There was no restriction on publication date. Studies were excluded if they were narrative systematic reviews or dissertations or if they described a postvention program but provided no evaluation. Because very few cost-effectiveness analyses were identified, articles describing "costs" of bereavement programs were also included. Studies were evaluated for quality using Centres for Evidence-Based Medicine Levels of Evidence, and for program effectiveness using Office of Justice Programs "What Works Repository" Analytic Framework. RESULTS: Of the 49 studies of suicide postvention programs retrieved, 16 met inclusion criteria for evaluation of study quality and evidence of effectiveness. Three target populations for postvention programs were identified: school-based, family-focused, and community-based. No protective effect of any postvention program could be determined for number of suicide deaths or suicide attempts from the available studies. Few positive effects of school-based postvention programs were found. One study reported negative effects of a suicide postvention. Gatekeeper training for proactive postvention was effective in increasing knowledge pertaining to crisis intervention among school personnel. Outreach at the scene of suicide was found to be helpful in encouraging survivors to attend a support group at a crisis centre and seek help in dealing with their loss. Contact with a counseling postvention for familial survivors (spouses, parents, children) of suicide generally helped reduce psychological distress in the short term. There was no statistical analysis of community-based suicide postvention programs; however media guidelines for reporting of suicide and suicide attempts have been adopted by mental health organizations in numerous countries. No analyses of cost-effectiveness of suicide postvention programs were found. CONCLUSION: Recommendations to provide guidance to policy-makers, administrators and clinicians are presented and directions for future research are outlined.

Use of school-based health centres for mental health support in Cape Breton, Nova Scotia.

OBJECTIVE: To determine whether students with self-reported needs for mental health support used school-based health centres (SBHCs) for this purpose. METHOD: A secondary analysis was conducted on self-reported data collected from 1629 high school students from Cape Breton, Nova Scotia. Descriptive statistics and logistic regression analyses were employed to determine the influence of sex, grade, sexual orientation, socioeconomic status (SES), school performance, social involvement, and health risk-taking behaviours on need for mental health support and use of SBHC for that purpose. RESULTS: One-half of surveyed students reported needs for mental health support. Risk for depression was the most commonly reported indicator of need. Only 13% of students visited a SBHC nurse for mental health support, and 4 times as many females than males used the SBHC for this purpose (20.4%, compared with 5.3%, P < 0.001). There was a significantly increased likelihood of use of SBHC for mental health support, given the presence of a greater number of need factors. Multivariate logistic regression determined that female sex (OR 5.57, 95% CI 3.07 to 10.09), lower SES factor (OR 1.19, 95% CI 1.11 to 1.28), sexual health risk-taking behaviours (OR 1.72, 95% CI 1.28 to 2.31), and suicidal behaviour (OR 1.83, 95% CI 1.48 to 2.27) were significantly associated with the use of SBHCs for mental health support. CONCLUSIONS: Substantial need for mental health support and significant unmet need were observed. In particular, male students underused the services relative to their self-reported need. Implications for SBHCs and directions for future research are discussed.

Teen suicide information on the internet: a systematic analysis of quality.

OBJECTIVE: To synthesize the literature on youth suicide risk factors (RFs) and prevention strategies (PSs); evaluate quality of information regarding youth suicide RFs and PSs found on selected Canadian websites; determine if website source was related to evidence-based rating (EBR); and determine the association of website quality indicators with EBR. METHODS: Five systematic reviews of youth suicide research were analyzed to assemble the evidence base for RFs and PSs. The top 20 most commonly accessed youth suicide information websites were analyzed for quality indicators and EBR. Univariate logistic regression was conducted to determine if quality indicators predicted statements supported by evidence (SSEs). Multivariate analysis was used to calculate adjusted odds ratios for SSEs and quality indicators. RESULTS: Only 44.2% of statements were SSEs. The 10 most highly ranked websites contained almost 80% of the total statements analyzed, and one-half had a negative EBR. Compared with government websites, nonprofit organization websites were more likely (OR 1.45, 95% CI 0.66 to 3.18), and personal and media websites were less likely (OR 0.62, 95% CI 0.26 to 1.47), to have a positive EBR. Crediting of an author (AOR 2.65, 95% CI 1.34 to 5.28), and recommendation to consult a health professional (AOR 2.08, 95% CI 1.18 to 3.68), increased the odds of SSEs. CONCLUSIONS: Fundamental to addressing youth suicide is the availability of high-quality, evidence-based information accessible to the public, health providers, and policy-makers. Many websites, including those sponsored by the federal government and national organizations, need to improve the evidence-based quality of the information provided.