Access to mental health services: The experiences of people with intellectual disabilities.

BACKGROUND: People with intellectual disability experience higher rates of mental health disorders than the rest of the population, and expert opinion holds that multiple barriers prevent people with intellectual disability from accessing appropriate services. METHODS: A qualitative study was designed to explore the lived experience of barriers and enablers to access to mental health services among people with intellectual disability. Interviews and focus groups were conducted with people with intellectual disability, carers and service providers. RESULTS: Barriers and enablers were identified across four key dimensions of access: utilization of services; service availability; relevance, effectiveness and access; and equity and access. These factors operated at both systemic and personal levels. CONCLUSIONS: The findings from this study provide empirical evidence of anecdotal experiences of access to mental health services and provide insight into the ways users, carers and service providers navigate an often hostile system and indicate further directions for research.

Tensions in perspectives on suicide prevention between men who have attempted suicide and their support networks: Secondary analysis of qualitative data.

BACKGROUND: Men generally have higher rates of suicide, despite fewer overt indicators of risk. Differences in presentation and response suggest a need to better understand why suicide prevention is less effective for men. OBJECTIVE: To explore the views of at-risk men, friends and family about the tensions inherent in suicide prevention and to consider how prevention may be improved. DESIGN: Secondary analysis of qualitative interview and focus group data, using thematic analysis techniques, alongside bracketing, construction and contextualisation. SETTING AND PARTICIPANTS: A total of 35 men who had recently made a suicide attempt participated in interviews, and 47 family and friends of men who had made a suicide attempt took part in focus groups. Participants recounted their experiences with men's suicide attempts and associated interventions, and suggested ways in which suicide prevention may be improved. RESULTS: Five tensions in perspectives emerged between men and their support networks, which complicated effective management of suicide risk: (i) respecting privacy vs monitoring risk, (ii) differentiating normal vs risky behaviour changes, (iii) familiarity vs anonymity in personal information disclosure, (iv) maintaining autonomy vs imposing constraints to limit risk, and (v) perceived need for vs failures of external support services. CONCLUSION: Tension between the different perspectives increased systemic stress, compounding problems and risk, thereby decreasing the effectiveness of detection of and interventions for men at risk of suicide. Suggested solutions included improving risk communication, reducing reliance on single source supports and increasing intervention flexibility in response to individual needs.

Preliminary Evaluation of a Brief Web and Mobile Phone Intervention for Men With Depression: Men's Positive Coping Strategies and Associated Depression, Resilience, and Work and Social Functioning.

BACKGROUND: Previous research has identified that men experiencing depression do not always access appropriate health services. Web-based interventions represent an alternative treatment option for men, are effective in reducing anxiety and depression, and have potential for wide dissemination. However, men do not access Web-based programs at the same rate as women. Programs with content explicitly tailored to men's mental health needs are required. OBJECTIVE: This study evaluated the applicability of Man Central, a new Web and mobile phone intervention for men with depression. The impact of the use of Man Central on depression, resilience, and work and social functioning was assessed. METHODS: A recruitment flier was distributed via social media, email networks, newsletters, research registers, and partner organizations. A single-group, repeated measures design was used. The primary outcome was symptoms of depression. Secondary outcomes included externalizing symptoms, resilience, and work and social functioning. Man Central comprises regular mood, symptom, and behavior monitoring, combined with three 15-min interactive sessions. Clinical features are grounded in cognitive behavior therapy and problem-solving therapy. A distinguishing feature is the incorporation of positive strategies identified by men as useful in preventing and managing depression. Participants were directed to use Man Central for a period of 4 weeks. Linear mixed modeling with intention-to-treat analysis assessed associations between the intervention and the primary and secondary outcomes. RESULTS: A total of 144 men aged between 18 and 68 years and with at least mild depression enrolled in the study. The symptoms most often monitored by men included motivation (471 instances), depression (399), sleep (323), anxiety (316), and stress (262). Reminders were scheduled by 60.4% (87/144). Significant improvements were observed in depression symptoms (P<.001, d=0.68), depression risk, and externalizing symptoms (P<.001, d=0.88) and work and social functioning (P<.001, d=0.78). No change was observed in measures of resilience. Participants reported satisfaction with the program, with a majority saying that it was easy (42/51, 82%) and convenient (41/51, 80%) to use. Study attrition was high; 27.1% (39/144) and 8.3% (12/144) of the participants provided complete follow-up data and partial follow-up data, respectively, whereas the majority (93/144, 64.6%) did not complete follow-up measures. CONCLUSIONS: This preliminary evaluation demonstrated the potential of using electronic health (eHealth) tools to deliver self-management strategies to men with depressive symptoms. Man Central may meet the treatment needs of a subgroup of depressed men who are willing to engage with an e-mental health program. With further research, it may provide an acceptable option to those unwilling or unable to access traditional mental health services. Given the limitations of the study design, prospective studies are required, using controlled designs to further elucidate the effect of the program over time.

A diabetes-specific e-mental health tool: Development, acceptability and outcomes of a feasibility study.

BACKGROUND: Psychological problems are frequently comorbid with diabetes and can be complex and time consuming to manage in general practice. They can also complicate diabetes management. OBJECTIVE: This pre-post, mixed-methods study examined whether a diabetes-specific online module, integrated into an existing e-mental health program, is acceptable to patients and helps to improve psychological wellbeing. METHODS: The study was conducted in three stages. First, qualitative information was obtained from consumers and practitioners to inform module content. Second, clinical content for the module was developed, including psychoeducational material and clinical content. In the final stage, acceptability and feasibility was evaluated in a group of patients with diabetes. RESULTS: Patients' satisfaction with and acceptance of the module was high. Significant improvement in mental health and diabetes outcomes was also observed. DISCUSSION: Preliminary evidence suggests that the online diabetes module may be a useful psychological support for patients with diabetes. Further controlled investigation is warranted.

Positive strategies men regularly use to prevent and manage depression: a national survey of Australian men.

BACKGROUND: Men are at greater risk than women of dying by suicide. One in eight will experience depression--a leading contributor to suicide--in their lifetime and men often delay seeking treatment. Previous research has focused on men's use of unhelpful coping strategies, with little emphasis on men's productive responses. The present study examines the positive strategies men use to prevent and manage depression. METHOD: A national online survey investigated Australian men's use of positive strategies, including 26 strategies specifically nominated by men in a previous qualitative study. Data were collected regarding frequency of use or openness to using untried strategies, depression risk, depression symptoms, demographic factors, and other strategies suggested by men. Multivariate regression analyses explored relationships between regular use of strategies and other variables. RESULTS: In total, 465 men aged between 18 and 74 years participated. The mean number of strategies used was 16.8 (SD 4.1) for preventing depression and 15.1 (SD 5.1) for management. The top five prevention strategies used regularly were eating healthily (54.2 %), keeping busy (50.1 %), exercising (44.9 %), humour (41.1 %) and helping others (35.7 %). The top five strategies used for management were taking time out (35.7 %), rewarding myself (35.1 %), keeping busy (35.1 %), exercising (33.3 %) and spending time with a pet (32.7 %). With untried strategies, a majority (58 %) were open to maintaining a relationship with a mentor, and nearly half were open to using meditation, mindfulness or gratitude exercises, seeing a health professional, or setting goals. In multivariate analyses, lower depression risk as measured by the Male Depression Risk Scale was associated with regular use of self-care, achievement-based and cognitive strategies, while lower scores on the Patient Health Questionnaire-9 was associated with regular use of cognitive strategies. CONCLUSIONS: The results demonstrate that the men in the study currently use, and are open to using, a broad range of practical, social, emotional, cognitive and problem-solving strategies to maintain their mental health. This is significant for men in the community who may not be in contact with professional health services and would benefit from health messages promoting positive strategies as effective tools in the prevention and management of depression.

What might interrupt men's suicide? Results from an online survey of men.

OBJECTIVES: Men are almost two times more likely to die by suicide than women, yet little research has focused on what is required to prevent suicide among men. This paper aims to investigate what factors interrupt suicidal behaviour in men, and to examine differences according to known suicide risk factors. SETTING: Australia. PARTICIPANTS: 251 Australian men aged 18 years and over who had made a suicide attempt 6-18 months prior to completing the survey. OUTCOMES: The survey canvassed the language men use to describe their depression and suicidality, warning signs, barriers to accessing help and what is needed to interrupt a suicide attempt. ORs and χ(2) were used to test for differences by age, geographic location and current depression severity. RESULTS: Of 299 men screened and eligible to participate, 251 completed all or part of the survey. Participants identified different words and warning signs for depression compared with suicidality. The most commonly endorsed barriers to accessing help were not wanting to burden others (66%) and having isolated themselves (63%). Men overwhelmingly endorsed 'I thought about the consequences for my family' as the factor which stopped a suicide attempt (67%). 'I need support from someone I really trust and respect' was also strongly endorsed. There were few differences by age, region or depression severity. CONCLUSIONS: Participants were able to identify signs, albeit often subtle ones, that they were becoming depressed or suicidal. Similarly, most were able to identify active strategies to interrupt this downward spiral. Men wanted others to notice changes in their behaviour, and to approach them without judgement.

Men's use of positive strategies for preventing and managing depression: A qualitative investigation.

BACKGROUND: One in eight men experience depression and men account for 75% of suicides. Previous research has focused on men's reluctance to seek help and use of unhelpful coping strategies. METHOD: Thematic analysis was used on transcripts from 21 focus groups and 24 in-depth interviews focused on positive strategies men use to prevent and manage depression. RESULTS: In total, 168 men were recruited and the majority (63%) reported no current depression. Four major themes were identified, where men: (1) used a broad variety of positive strategies and made clear distinctions between prevention and management, (2) used strategies that were "typically masculine", as well as challenged expectations of manliness, (3) felt powerless in the face of suicide, and (4) had accumulated wisdom they felt was beneficial for others. Men specifically advised others to talk about problems. Prevention relied upon regular routines for "balance", while management relied upon "having a plan". LIMITATIONS: The majority of the men were aged over 55 years and highly educated. Younger men or those without tertiary education may favour different strategies. CONCLUSIONS: In contrast to using only unhelpful strategies, the men used a broad range of positive strategies and adapted their use depending on mood, symptom or problem severity. Use of positive strategies was sophisticated, nuanced, and often underlined by a guiding philosophy. Rather than simply reacting to problems, men actively engaged in preventing the development of depressed moods, and made conscious choices about when or how to take action. Clinical and public health implications are discussed.

What Interrupts Suicide Attempts in Men: A Qualitative Study.

Despite higher rates of suicide in men, there is a dearth of research examining the perspectives and experiences of males at risk of suicide, particularly in terms of understanding how interventions can be tailored to men's specific needs. The current study aimed to examine factors assisting, complicating or inhibiting interventions for men at risk, as well as outlining the roles of family, friends and others in male suicide prevention. Thirty-five male suicide survivors completed one-to-one interviews, and forty-seven family and friends of male suicide survivors participated in eight focus groups. Thematic analysis revealed five major themes: (1) development of suicidal behaviours tends to follow a common path associated with specific types of risk factors (disrupted mood, unhelpful stoic beliefs and values, avoidant coping strategies, stressors), (2) men at risk of suicide tend to systematically misinterpret changes in their behaviour and thinking, (3) understanding mood and behavioural changes in men enables identification of opportunities to interrupt suicide progression, (4) distraction, provision of practical and emotional supports, along with professional intervention may effectively interrupt acute risk of harm, and (5) suicidal ideation may be reduced through provision of practical help to manage crises, and helping men to focus on obligations and their role within families. Findings suggest that interventions for men at risk of suicidal behaviours need to be tailored to specific risk indicators, developmental factors, care needs and individuals' preferences. To our knowledge this is the first qualitative study to explore the experiences of both suicidal men and their family/friends after a suicide attempt, with the view to improve understanding of the processes which are effective in interrupting suicide and better inform interventions for men at risk.