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Biomedical subjects

Benedetto Saraceno

Publications and source records attributed to Benedetto Saraceno.

At least 19 recordsLinked to original sources
PubMed2006

WHO/WFN Survey of neurological services: a worldwide perspective.

According to the findings obtained in the context of a Global Initiative on Neurology and Public Health carried out by the World Health Organization (WHO), there has been a lack of reliable and comparative data on services and other resources for neurological disorders in many parts of the world. In view of these findings and in collaboration with the World Federation of Neurology (WFN), WHO has recently organized an international Survey of Country Resources for Neurological Disorders, which involved 109 countries and covered over 90% of the world's population. This large WHO/WFN collaborative endeavour collected expert information on a number of aspects of neurological care provision around the world including availability of neurological services in primary care; human resources for neurological disorders; sub-specialized neurological services; primary method of financing of neurological care; and disability benefits for patients with neurological disorders. The WHO/WFN Survey results clearly demonstrate that there are inadequate resources for patients with neurological disorders in most parts of the world, and highlight inequalities in the access to neurological care across different populations, and in particular in those living in low-income countries and in developing regions of the world. The key findings of the WHO/WFN Survey including their impact on delivery of neurological care around the world are presented and discussed in this paper. The entire set of WHO/WFN Survey results including numerous tables, graphs and accompanying commentaries can be found in the WHO/WFN Atlas of Country Resources for Neurological Disorders, which is available on request from WHO or at http://www.who.int/mental_health/neurology/ .

Global Health↗
PubMed2006

Monitoring of mental health systems and services: comparison of four existing indicator schemes.

BACKGROUND: A public mental health indicator scheme may be defined as a systematic collection of brief proxy measures that represent summary information on variables that are potentially influenced by or relevant to mental health systems, programmes and services. Existing public mental health indicator schemes have been developed in or for high-income countries. METHOD: The paper describes and compares four existing high-income country public mental health indicator schemes and highlights key observations. RESULTS: The range of indicators and subclasses of indicators covered by the four existing schemes is large. There was only one item (indicator) that was covered by more than one scheme. CONCLUSIONS: The variety of possibilities in indicators and types of indicators suggests a lack of consensus in the essential contents of an indicator scheme. There is a need for a public mental health indicator scheme that is applicable in resource-poor countries.

Cross-Cultural Comparison↗
PubMed2006

Seven criteria for improving effectiveness trials in psychiatry.

BACKGROUND: There are no published criteria for improving the quality of effectiveness of randomized controlled trials (RCTs) in psychiatry. METHOD: The authors review and systematize the relevant literature on effectiveness trials, with particular reference to psychiatry. RESULTS: In planning effectiveness RCTs in psychiatry, seven sets of issues need to be carefully considered: (i) study question (i.e. is the study question expressed in an answerable way?); (ii) reference population (i.e. what is the reference group or subgroup to which the trial results should be generalized?); (iii) patient sample (i.e. how far does the sample reflect the target population?); (iv) study settings (i.e. how representative are the study settings of routine clinical sites?); (v) study interventions (i.e. is the study intervention manualized, acceptable to patients and suitable for widespread use?); (vi) control condition (i.e. are the key characteristics of the control condition well described, and do they vary within and between sites?); and (vii) bias (e.g. attrition, blinding, concealment, consent and contamination). CONCLUSIONS: More effectiveness trials are needed which have sufficient statistical power to provide precise answers to assist clinicians in making treatment decisions. The development of effectiveness trials in psychiatry, both for studies of individual treatments and for service evaluations, may be enhanced by carefully considering and justifying decisions in relation to each of the seven key headings proposed here.

Bias↗
PubMed2006

Mental health assistance to populations affected by disasters: World Health Organization's role.

In this article, the authors describe the role of the World Health Organization (WHO) in mental health post-disaster recovery. The article covers the mandate and structure of WHO, mental health activities by the WHO Department of Mental Health and Substance Abuse, WHO-supported principles and strategies in mental health post-disaster recovery, and available WHO technical assistance. The paper outlines a public mental health approach to make very basic mental health services broadly available in post-disaster countries. Using examples based on the Asian tsunami experience, suggestions for delivering mental health assistance are made. The response to mental health of disaster victims should be seen in the context of national health priorities.

Asia, Southeastern↗
PubMed2006

World Health Organization's Mental Health Atlas 2005:implications for policy development.

In 2005, the World Health Organization (WHO) launched the second edition of the Mental Health Atlas, consisting of revised and updated information on mental health from countries. The sources of information included the mental health focal points in the Ministries of Health, published literature and unpublished reports available to WHO. The results show that global mental health resources remain low and grossly inadequate to respond to the high level of need. In addition, the revised Atlas shows that the improvements over the period 2001 to 2004 are very small. Imbalances across income groups of countries remain largely the same. Enhancement in resources devoted to mental health is urgently needed, especially in low- and middle-income countries.

Journal Article↗
PubMed2005

Advocacy for mental health: roles for consumer and family organizations and governments.

The World Health Organization urges countries to become more active in advocacy efforts to put mental health on governments' agendas. Health policy makers, planners and managers, advocacy groups, consumer and family organizations, through their different roles and actions, can move the mental health agenda forward. This paper outlines the importance of the advocacy movement, describes some of the roles and functions of the different groups and identifies some specific actions that can be adopted by Ministries of Health. The mental health advocacy movement has developed over the last 30 years as a means of combating stigma and prejudice against people with mental disorders and improving services. Consumer and family organizations and related NGOs have been able to influence governments on mental health policies and laws and educating the public on social integration of people with mental disorders. Governments can promote the development of a strong mental health advocacy sector without compromising this sector's independence. For instance, they can publish and distribute a directory of mental health advocacy groups, include them in their mental health activities and help fledgling groups become more established. There are also some advocacy functions that government officials can, and indeed, should perform themselves. Officials in the ministry of health can persuade officials in other branches of government to make mental health more of a priority, support advocacy activities with both general health workers and mental health workers and carry out public information campaigns about mental disorders and how to maintain good mental health. In conclusion, the World Health Organization believes mental health advocacy is one of the pillars to improve mental health care and the human rights of people with mental disorders. It is hoped that the recommendations in this article will help government officials and activists to strengthen national advocacy movements.

Consumer Organizations↗
PubMed2005

Mental and social health in disasters: relating qualitative social science research and the Sphere standard.

Increasingly, social scientists interested in mental and social health conduct qualitative research to chronicle the experiences of and humanitarian responses to disaster We reviewed the qualitative social science research literature in relation to a significant policy document, the Sphere Handbook, which includes a minimum standard in disaster response addressing "mental and social aspects of health", involving 12 interventions indicators. The reviewed literature in general supports the relevance of the Sphere social health intervention indicators. However, social scientists' chronicles of the diversity and complexity of communities and responses to disaster illustrate that these social interventions cannot be assumed helpful in all settings and times. With respect to Sphere mental health intervention indicators, the research largely ignores the existence and well-being of persons with pre-existing, severe mental disorders in disasters, whose well-being is addressed by the relevant Sphere standard. Instead, many social scientists focus on and question the relevance of posttraumatic stress disorder-focused interventions, which are common after some disasters and which are not specifically covered by the Sphere standard. Overall, social scientists appear to call for a social response that more actively engages the political, social, and economic causes of suffering, and that recognizes the social complexities and flux that accompany disaster. By relating social science research to the Sphere standard for mental and social health, this review informs and illustrates the standard and identifies areas of needed research.

Altruism↗
PubMed2005

Mental and social health during and after acute emergencies: emerging consensus?

Mental health care programmes during and after acute emergencies in resource-poor countries have been considered controversial. There is no agreement on the public health value of the post-traumatic stress disorder concept and no agreement on the appropriateness of vertical (separate) trauma-focused services. A range of social and mental health intervention strategies and principles seem, however, to have the broad support of expert opinion. Despite continuing debate, there is emerging agreement on what entails good public health practice in respect of mental health. In terms of early interventions, this agreement is exemplified by the recent inclusion of a "mental and social aspects of health" standard in the Sphere handbook's revision on minimal standards in disaster response. This affirmation of emerging agreement is important and should give clear messages to health planners.

Adaptation, Psychological↗
PubMed2005

The public mental health significance of research on socio-economic factors in schizophrenia and major depression.

This paper reviews the epidemiological research evidence on the role of socio-economic factors in the origins and disease experience of schizophrenia and major depression. The studies were conducted in different countries over many years. Although their findings are divided in their support of either the social causation or the drift hypothesis, all of them agree that persons with these disorders are at high disadvantage in society. Several factors for this have been identified. These studies provide the rationale for community-based interventions that have to be guided by principles of equity in the distribution of resources and grounded in biopsychosocial models of care that comprehensively answer the needs of the affected populations.

Journal Article↗
PubMed2004

The treatment gap in mental health care.

Mental disorders are highly prevalent and cause considerable suffering and disease burden. To compound this public health problem, many individuals with psychiatric disorders remain untreated although effective treatments exist. We examine the extent of this treatment gap. We reviewed community-based psychiatric epidemiology studies that used standardized diagnostic instruments and included data on the percentage of individuals receiving care for schizophrenia and other non-affective psychotic disorders, major depression, dysthymia, bipolar disorder, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), and alcohol abuse or dependence. The median rates of untreated cases of these disorders were calculated across the studies. Examples of the estimation of the treatment gap for WHO regions are also presented. Thirty-seven studies had information on service utilization. The median treatment gap for schizophrenia, including other non-affective psychosis, was 32.2%. For other disorders the gap was: depression, 56.3%; dysthymia, 56.0%; bipolar disorder, 50.2%; panic disorder, 55.9%; GAD, 57.5%; and OCD, 57.3%. Alcohol abuse and dependence had the widest treatment gap at 78.1%. The treatment gap for mental disorders is universally large, though it varies across regions. It is likely that the gap reported here is an underestimate due to the unavailability of community-based data from developing countries where services are scarcer. To address this major public health challenge, WHO has adopted in 2002 a global action programme that has been endorsed by the Member States.

Adolescent↗
PubMed2004

Brief report - mental health research on low- and middle-income countries in indexed journals: a preliminary assessment.

BACKGROUND: Mental health research focused on low- and middle-income (LAMI) countries is needed in view of the burden of neuropsychiatric diseases and the deficiency of mental health resources in these countries. AIMS OF THE STUDY: To examine whether mental health research publications on LAMI countries address issues that are likely to influence public mental health. METHOD: Four databases were searched for years 2000 and 2001 with subject headings related to mental disorders, mental health services, somatic therapies and psychotherapy. Countries were categorized into income groups according to World Bank (2000) criteria. The title, index words and abstracts were reviewed. RESULTS: Almost 55% of publications related to ten LAMI countries. One sixth of research publications related to services/policies, but less than 1% were devoted to economic evaluation. Affective disorders, self-inflicted injuries and mental retardation were under-researched. DISCUSSION: The geographic spread of internationally accessible mental health research publications is limited. Moreover, publications from LAMI countries often do not address public mental health issues. Use of a single rater might have led to some arbitrariness in classification of articles and some relevant articles would have been missed because of our inability to include all relevant databases. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Sustained support by various stakeholders is needed for research that can inform mental health care provision and use in LAMI countries. IMPLICATIONS FOR HEALTH POLICIES: Scientific research can inform mechanisms that influence policy and public health if adequate attention is paid to dissemination of findings to end users. IMPLICATIONS FOR FURTHER RESEARCH: There is a need to focus research in LAMI countries on mental health conditions causing high burden that are currently under-researched (e.g. depression, mental retardation, self-inflicted injuries), policy and service issues, and mental health economics.

Abstracting and Indexing↗
PubMed2004

Mental health: scarce resources need new paradigms.

Mental disorders represent a major challenge to global development worldwide. Effective (and in some cases cost-effective) interventions are available for almost all of them. However, these interventions are often not implemented. Unknown variables, quite similar among themselves across the world, can have a strong influence in increasing the service quality in spite of the differences in resources and technologies. These unknown variables often result from the adoption of paradigms which are relatively independent from resources and technologies. We examine here four such paradigms.

Journal Article↗
PubMed2004

Research for Change: the role of scientific journals publishing mental health research.

There is an enormous gap between the burden of mental disorders and mental health resources in low- and middle-income countries. The Mental Health: Global Action Programme of the World Health Organization (WHO) envisions an active role for research in the multidimensional efforts required to change the current mental health situation in these countries (Research for Change). WHO's strategies to achieve this include developing a research policy and a priority agenda at country level with active collaboration from all stakeholders, building research capacity and infrastructure and involving scientific journals to stimulate and disseminate public health oriented research. A recently agreed joint statement by editors of prominent journals publishing mental health research and WHO sets major objectives and some possible strategies for achieving this. WHO is committed to making Research for Change a reality by working with partners who share this aim.

Journal Article↗