Walk-in mental health: Bridging barriers in a pandemic

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Abstract

‘Single Session Therapy’ (SST) is a service delivery model that seeks to provide an evidence-based, solution-focused, brief intervention within a single therapy session. The stand-alone session affords the opportunity to provide brief psychological interventions while clients await access to longer-term services. The COVID-19 pandemic has adversely impacted individuals’ mental health. However, the majority of research has investigated patient mental health within hospital settings and community organizations that offer long-term services, whereas minimal research has focused on mental health concerns during COVID-19 within an SST model. The primary aim of the study was to measure client experiences of a brief mental health service. The nature of client mental health concerns who access such services at various points during a pandemic was also investigated. The current study utilized client feedback forms and the Computerized Adaptive Testing—Mental Health (CAT-MH) to measure client experiences and mental health concerns. Qualitative analysis of client feedback forms revealed themes of emotional (e.g., safe space) and informational support (e.g., referrals). Clients also reported reduced barriers to accessing services (e.g., no appointment necessary, no cost), as well as limitations (e.g., not enough sessions) of the Walk-in clinic. Profile analysis of the CAT-MH data indicated that clients had higher rates of depression before COVID-19 ( M = 64.2, SD = 13.07) as compared to during the pandemic ( M = 59.78, SD = 16.87). In contrast, higher rates of positive suicidality flags were reported during the pandemic ( n = 54) as compared to before ( n = 29). The lower reported rates of depression but higher rate of suicidality during the pandemic was an unanticipated finding that contradicted prior research, to which possible explanations are explored. Taken together, the results demonstrate the positive experiences of clients who access a single session therapy.

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Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic

(2021)

Background Before 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative. In this study, we aimed to quantify the impact of the COVID-19 pandemic on the prevalence and burden of major depressive disorder and anxiety disorders globally in 2020. Methods We conducted a systematic review of data reporting the prevalence of major depressive disorder and anxiety disorders during the COVID-19 pandemic and published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google Scholar, preprint servers, grey literature sources, and consulted experts. Eligible studies reported prevalence of depressive or anxiety disorders that were representative of the general population during the COVID-19 pandemic and had a pre-pandemic baseline. We used the assembled data in a meta-regression to estimate change in the prevalence of major depressive disorder and anxiety disorders between pre-pandemic and mid-pandemic (using periods as defined by each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2 infection rate, and daily excess mortality rate). We then used this model to estimate the change from pre-pandemic prevalence (estimated using Disease Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and location. We used final prevalence estimates and disability weights to estimate years lived with disability and disability-adjusted life-years (DALYs) for major depressive disorder and anxiety disorders. Findings We identified 5683 unique data sources, of which 48 met inclusion criteria (46 studies met criteria for major depressive disorder and 27 for anxiety disorders). Two COVID-19 impact indicators, specifically daily SARS-CoV-2 infection rates and reductions in human mobility, were associated with increased prevalence of major depressive disorder (regression coefficient [ B ] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1 [7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders (0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p<0·0001]. Females were affected more by the pandemic than males ( B 0·1 [0·1 to 0·2; p=0·0001] for major depressive disorder, 0·1 [0·1 to 0·2; p=0·0001] for anxiety disorders) and younger age groups were more affected than older age groups (−0·007 [–0·009 to −0·006; p=0·0001] for major depressive disorder, −0·003 [–0·005 to −0·002; p=0·0001] for anxiety disorders). We estimated that the locations hit hardest by the pandemic in 2020, as measured with decreased human mobility and daily SARS-CoV-2 infection rate, had the greatest increases in prevalence of major depressive disorder and anxiety disorders. We estimated an additional 53·2 million (44·8 to 62·9) cases of major depressive disorder globally (an increase of 27·6% [25·1 to 30·3]) due to the COVID-19 pandemic, such that the total prevalence was 3152·9 cases (2722·5 to 3654·5) per 100 000 population. We also estimated an additional 76·2 million (64·3 to 90·6) cases of anxiety disorders globally (an increase of 25·6% [23·2 to 28·0]), such that the total prevalence was 4802·4 cases (4108·2 to 5588·6) per 100 000 population. Altogether, major depressive disorder caused 49·4 million (33·6 to 68·7) DALYs and anxiety disorders caused 44·5 million (30·2 to 62·5) DALYs globally in 2020. Interpretation This pandemic has created an increased urgency to strengthen mental health systems in most countries. Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option. Funding Queensland Health, National Health and Medical Research Council, and the Bill and Melinda Gates Foundation.

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Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.

Philip Wang, Sergio Aguilar-Gaxiola, Jordi Alonso … (2007)

Mental disorders are major causes of disability worldwide, including in the low-income and middle-income countries least able to bear such burdens. We describe mental health care in 17 countries participating in the WHO world mental health (WMH) survey initiative and examine unmet needs for treatment. Face-to-face household surveys were undertaken with 84,850 community adult respondents in low-income or middle-income (Colombia, Lebanon, Mexico, Nigeria, China, South Africa, Ukraine) and high-income countries (Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Spain, USA). Prevalence and severity of mental disorders over 12 months, and mental health service use, were assessed with the WMH composite international diagnostic interview. Logistic regression analysis was used to study sociodemographic predictors of receiving any 12-month services. The number of respondents using any 12-month mental health services (57 [2%; Nigeria] to 1477 [18%; USA]) was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries' percentages of gross domestic product spent on health care. Although seriousness of disorder was related to service use, only five (11%; China) to 46 (61%; Belgium) of patients with severe disorders received any care in the previous year. General medical sectors were the largest sources of mental health services. For respondents initiating treatments, 152 (70%; Germany) to 129 (95%; Italy) received any follow-up care, and one (10%; Nigeria) to 113 (42%; France) received treatments meeting minimum standards for adequacy. Patients who were male, married, less-educated, and at the extremes of age or income were treated less. Unmet needs for mental health treatment are pervasive and especially concerning in less-developed countries. Alleviation of these unmet needs will require expansion and optimum allocation of treatment resources.

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Stress and health: major findings and policy implications.

Peggy A. Thoits (2010)

Forty decades of sociological stress research offer five major findings. First, when stressors (negative events, chronic strains, and traumas) are measured comprehensively, their damaging impacts on physical and mental health are substantial. Second, differential exposure to stressful experiences is a primary way that gender, racial-ethnic, marital status, and social class inequalities in physical and mental health are produced. Third, minority group members are additionally harmed by discrimination stress. Fourth, stressors proliferate over the life course and across generations, widening health gaps between advantaged and disadvantaged group members. Fifth, the impacts of stressors on health and well-being are reduced when persons have high levels of mastery, self-esteem, and/or social support. With respect to policy, to help individuals cope with adversity, tried and true coping and support interventions should be more widely disseminated and employed. To address health inequalities, the structural conditions that put people at risk of stressors should be a focus of programs and policies at macro and meso levels of intervention. Programs and policies also should target children who are at lifetime risk of ill health and distress due to exposure to poverty and stressful family circumstances.

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Author and article information

Contributors

Ian Wellspring:

ORCID: https://orcid.org/0000-0001-7683-099X

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Kirthana Ganesh:

ORCID: https://orcid.org/0000-0001-5505-5242

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – review & editing

Kimberly Kreklewetz: Role: ConceptualizationRole: Data curationRole: SupervisionRole: Writing – review & editing

Emily Lund: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLOS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 31 May 2024

Publication date Collection: 2024

Volume: 19

Issue: 5

Electronic Location Identifier: e0302543

Affiliations

[001] University of British Columbia (Okanagan), Kelowna, Canada

The University of Alabama, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: iwellspr@ 123456mail.ubc.ca

Author information

Ian Wellspring https://orcid.org/0000-0001-7683-099X

Kirthana Ganesh https://orcid.org/0000-0001-5505-5242

Article

Publisher ID: PONE-D-23-00898

DOI: 10.1371/journal.pone.0302543

PMC ID: 11142450

PubMed ID: 38820293

SO-VID: 20375fc5-61a0-44c0-b507-7401716de5a8

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 11 January 2023

Date accepted : 8 April 2024

Page count

Figures: 6, Tables: 2, Pages: 20

Funding

Funded by: The Walk-in Wellness clinic at the University of British Columbia (Okanagan)

The Walk-in Wellness clinic at the University of British Columbia (Okanagan) is funded by the private donors who wish to remain anonymous. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability The data underlying the results presented in the study are available from the primary lead author (Ian Wellspring) at iwellspr@ 123456mail.ubc.ca . The data cannot be shared publicly as the data is also collected by the developers for the CAT-MH. Should an individual be interested in accessing the data they are respectfully directed to contact a representative from CAT-MH (Cody Brannon) at cbrannan@ 123456adaptivetestingtechnologies.com , in addition to contacting the primary researcher. Further, it should be noted that the co-authors re-conducted the analyses (i.e., ran the code) following the steps outlined in the methods section of the paper and obtained similar results. As such, the findings of the current study should be replicated following the provided data analyses steps. Lastly, the authors of the current paper have special access privileges to the data given that the CAT-MH data is shared under the agreement between UBCO and CAT-MH. Specifically, the agreement states that the CAT-MH should be used for clinical purposes within the WIWC and given that the authors are clinicians within the WIWC they have special access to the data that other clinicians who are not integrated in the WIWC have access to. It should also be reiterated that the authors only have access to CAT-MH data related to the WIWC and do not have access to CAT-MH data from other site locations across North America.

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Walk-in mental health: Bridging barriers in a pandemic

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Novel Coronavirus Disease COVID-19

Most cited references 76

Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic

Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.

Stress and health: major findings and policy implications.

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