Clergy in the UK continue to provide health and social care services. However, collaboration between mental health services and clergy may be problematic, particularly in the resolution of conflicting beliefs and therapeutic modalities. For example, belief in demonic possession and other supernatural causes of mental illness, which are contentious among secular medical practitioners, remain prevalent in many ethnoreligious communities. Thus, interpretations of illness by clergy within health systems may be crucial to appropriate intervention for people with mental illness. However, clergy conceptualizations of suffering also reveal something about the secularization within religious institutions through the despiritualization of particular phenomena. This paper on Christian clergy beliefs and attitudes to supernatural explanations, describes how the negotiation of such beliefs are complex and often equivocal among mainstream clergy but integral to the Pentecostal churches and evangelical clergy in the mainstream, institutional churches. These beliefs and their implications for collaboration with psychiatry are discussed in the context of a rapidly changing religious and cultural landscape.
Despite the advance of secularizing influences in many western societies, religion and faith-based organizations play a significant role in the lives of many individuals and communities. Despite this, little is known about what clergy do when faced with mental health problems among their communities. Based on an analysis of in-depth interviews with U.K. Christian, Muslim and Jewish clergy this article examines models of pastoral care provided within different faith groups. The provision of such care was generally influenced by religious tradition and beliefs, community integrity and mission. Implications of the findings for collaboration with pastoral care are discussed.
ObjectivesOral health of people with severe mental illness (SMI) remains an important public health issue with some evidence pointing suboptimal dental health outcomes. We test the hypotheses that individuals with SMI have lower contact with dental services and higher levels of fillings and extractions. We also examine effect modification by age.
ApproachWe used linked administrative data from general practitioner (GP) records, hospital admissions data and dental payment system data to examine dental service use and treatments (extractions, fillings, crowns and x-rays) among the Northern Ireland hospital population between January 2015 and November 2019 (N=798,564). Logistic regression examined the association of SMI with dental service use and treatments, controlling for socio-demographic characteristics. In a further series of models, the interaction of SMI and age-group was examined.
ResultsAn estimated 1.2% (9,656) recorded an SMI diagnosis from hospital records at some point during follow-up. Over two-thirds (67.2%) of the non-SMI hospital population received any dental treatment compared with 62.2% of persons SMI-diagnosed. After adjusting for available socio-demographic characteristics, analysis indicated lower levels of dental service use (OR=0.80, 95% CI=0.77, 0.84), including lower likelihood of fillings (OR=0.81, 0.77, 0.84) and x-rays (OR=0.77, 0.74, 0.81), but higher levels of extractions (OR=1.23, 1.18, 1.29) among patients with SMI. We also found effect modification by age-group: while older age was generally associated with higher likelihood of extractions and crowns, interaction analysis points to lower likelihood of all four dental treatments among older individuals with SMI.
ConclusionsOur findings of lower engagement with dental services, lower levels of remedial treatments and higher levels of tooth loss raise concerns about availability, access, and promotion of routine dental care for people with SMI. There is a need for improved understanding of barriers to treatment and development of psychoeducational interventions.
IntroductionWhile chronic disease is a risk factor for dementia (Shang et al., 2020) studies addressing multimorbidity and dementia risk are limited. Multimorbidity leads to steeper dementia progression (Bauer, 2014; Haaksma, 2019) impacting cognitive dysfunction, cognitive decline and impairment (Wei, 2020; Vassilaki, 2015). Multimorbidity has generally been examined using a dose- response disease count, something cited as impractical for clinicians due to information deficits on identifying disease specific pathways (Whitty, 2020). Thus, differentiating disease clusters and dementia risk will provide insight into the pathophysiology of dementia, while informing priority targets for early intervention, potentially reducing burden and secondary care costs.
AimTo investigate dementia risk and mortality in older adults with different disease patterns, characteristics of hospital admissions, medication use and the role of locale of residence.
Data linkage and analysisWe used national data defined by the NHAIS, including basic demographics for all patients aged fifty-five plus and registered with a GP in Northern Ireland. The linked data comprised: Patient Admissions and Discharges (from 2013-2021); Electronically captured prescribing data, area-type of usual residence; Multiple Deprivation Indicators; and GRO mortality data (including cause of death). We identified multimorbidity through validated algorithms for ICD-10 coding of thirty morbidities in administrative hospital diagnostics data (Tonelli et al., 2019). The same data identified dementia-free patients at baseline. Latent Class Analysis assigned patient groups by the patterning of multimorbidity states, following them through the study period, with analysis in relation to subsequent diagnoses of both clinical dementia and mortality. As age has a potential modifier effect we tested through age group stratified analyses. A series of multinomial logistic regression models further examine (for the multimorbidity sub-groups of interest) risks associated socio-demographic, socio-economic, medication use and household indicators at the individual, family and area level.
ResultsMultimorbidity occurs in two thirds, approximately, of this hospital population of older adults. By age sixty-five years, most people are multimorbid. We identify subgroups of multimorbidity associated with dementia onset and mortality, combinations of diabetes, hypertension, chronic kidney disease and cancer multimorbidity are highlighted as higher-risk conditions for increased dementia incidence and mortality. Greater disease burden is associated with frequent healthcare service use, medication use and is more common in the most socioeconomically deprived, compared with the least deprived.
DiscussionEvidence on multimorbidity patterns and dementia is limited (Grande, 2021). Our study suggests that people with combinations of diabetes, hypertension, chronic kidney disease and cancer multimorbidity are associated with increased risks for dementia and socio demographic and economic circumstances further increase this risk. Overlapping combinations comprising chronic kidney disease + hypertension, or diabetes + hypertension, were a significant proportion of total secondary care costs for patients with multimorbidity; combinations comprising chronic heart failure + chronic kidney disease + hypertension had the highest proportion of total cost from potentially preventable emergency admissions (Stokes et al., 2021). Our finding support the body and mind connection in dementia development. Thus, we note that cardiovascular health is associated with dementia (Grande, 2021). Often described as a heart-brain connection, cardiovascular disease leads to higher dementia risk due to a number of mechanisms including but not limited to chronic inflammation (Grande, 2021). Identifying such high-risk groups will facilitate tailored interventions for dementia prevention and the reduction of healthcare use and costs.
Faith-based organisations, especially those related to specific ethnic or migrant groups, are increasingly viewed by secular Western government agencies as potential collaborators in community health and welfare programmes. Although clergy are often called upon to provide mental health pastoral care, their response to such problems remains relatively unexamined. This paper examines how clergy working in multiethnic settings do not always have the answers that people want, or perhaps need, to problems of misfortune and suffering. In the UK these barriers can be attributed, generally, to a lack of training on mental health problems and minimal collaboration with health services. The current paper attempts to highlight the dilemmas of the established churches' involvement in mental health care in the context of diversity. We explore the inability of established churches to accommodate African and other spiritual beliefs and practices related to the etiology and treatment of mental health problems.
The psychological consequences of sexual abuse are generally serious and enduring, particularly when the perpetrator is known and trusted by the survivor. This paper explores the experiences of five contemplative nuns who were sexually abused by priests and the spiritual journeys that followed. In the context of an ethnographic study of contemplative practice, participant observation and in-depth interviews were used to examine the ways that the nuns sought to make sense of their experiences through a long process of solitary introspection. The pursuit of meaning was shaped by religious beliefs relating to forgiveness, sacrifice, and salvation. Thus, trauma was transformed into a symbolic religious narrative that shaped their sense of identity. They were able to restructure core beliefs and to manage their current relationships with priests more securely. They described regaining their spiritual well-being in ways that suggest a form of posttraumatic spiritual growth. We conclude by discussing the findings in the light of the existing literature on the interaction of trauma and spirituality.
Background:Critiques of the validity of the DSM diagnostic criteria for depressive disorder argue that it fails to differentiate between abnormal sadness due to internal dysfunction or depression (sadness without an identifiable cause), and normal sadness (sadness with a clear cause).Aims and Methods:A population survey was undertaken in adult education centres in Spain aiming to explore beliefs about depression and normal sadness. Two hypothetical case vignettes portrayed individuals experiencing deep sadness, both fulfilling criteria for major depressive disorder (DSM-IV), one with a clear cause, the other without an identifiable cause. Three hundred and forty-four (344) questionnaires were obtained (95% response rate).Results:Participants statistically significantly differentiated between the sadness- with-cause vignette, seen more frequently as a normal response, while the one without a cause was seen as pathological. Help-seeking behaviour recommendations followed this distinction: a medical option was statistically significantly more common when there was no cause for sadness. Socio-cultural variation in how people understand and deal with sadness was also found.Conclusions:This study emphasizes the importance of taking into account the context in which depressive symptoms occur as it seems that the absence of an appropriate context is what makes people conceptualize them as abnormal. It also raises questions about the lack of face validity of the current diagnostic classification for depressive disorder that exclusively uses descriptive criteria.
The COVID-19 pandemic has affected mental health and social connections. Older people may be disproportionately affected, placing them at increased risk for complex mental ill-health outcomes and quality of life undermined by anxiety and depression. Understanding gender differences in the determinants of anxiety and depression symptoms is crucial to policy and practice. This study aims to examine gender-specific symptom subtypes (and subthreshold symptoms) in an older English population sampled during the COVID period, in relation to their socio-demographic, social, and health circumstances. The sample comprises all individuals aged 50 years or older and included in the English Longitudinal Study of Ageing COVID-19 sub-study conducted during June–July 2020. Latent class analysis (LCA) defined indicative sample subgroups of clinically relevant anxiety and depression. Multinomial logistic regression assessed associations between socio-demographic characteristics, health and social care indicators, loneliness, and pre-pandemic mental ill-health. LCA derived three classes of self-reported depression and anxiety: for females (1) comorbid depression and anxiety (19.9% of the sample), (2) depression and subthreshold anxiety (31.6%), and (3) no or low symptoms of depression and anxiety (48.5%), and for males (1) comorbid depression and anxiety (12.8%), (2) subthreshold anxiety and depression (29.6%), and (3) no or low depression and anxiety (57.6%). Multinomial logistic regression analyses indicate that compared to those with low/no mental health symptoms, severity of pandemic-era mental ill-health was positively associated with pre-pandemic mental health levels, worry over finances, having access to essentials, loneliness, and access to health and social care services. Findings support the persistence of comorbidity of both depression and anxiety in the pandemic period. Results may inform government health strategy on interventions to prevent social isolation and mitigate the effects of the pandemic on deteriorating ...
ObjectiveHealth and Social Care (HSC) workers are at high risk of job-related stress, burnout and mental ill-health. This study examines differences in self-reported mental health and psychotropic medication uptake across HSC occupational groups. MethodNorthern Ireland (NI) data linkage study of people working in the Health and Care sector, aged between twenty and sixty-four years, enumerated at the 2011 Northern Ireland Census and living in private households, and their uptake of prescribed psychotropic medications during 2011-2012 (using data derived from routine electronically captured information on prescriptions issued within the NHS and linked at an individual level using a NI-specific Health and Care key identifier). Comparing HSC workers with all those professionals not involved in HSC occupations, we used multinomial logistic regression to examine (a) self-reported chronic mental illness and (b) uptake of psychotropic medication by occupational groups adjusting for age, sex and socio-demographic circumstance. ResultsWhen compared against other professionals highest risks for mental health problems (associated with psychotropic prescription uptake) were associated with nursing/midwifery (OR = 1.25: 95{%}CI = 1.17-1.33; OR = 1.84: 1.58-2.15 for females and males respectively), welfare (OR = 1.34: 1.21-1.48; OR = 1.71: 1.44-2.03) and formal caregiving roles (OR = 1.42: 1.31-1.53; OR = 1.70: 1.50-1.91), again for females/males respectively). These higher risk professions record notable increases in psychotropic medication use. ConclusionWorking in the Health and Social Care sector, irrespective of gender, may be more stressful than other jobs. Additionally, self-reported mental ill-health and psychotropic medication treatment both appear to be associated with social class inequity.
Background While employment in general promotes positive health and wellbeing, a number of studies show disparities in mental health across occupational groupings (Bell et al., 2014; Stansfield et al. 2011). However, definitive studies to allow estimation of prevalence and risk across a range of occupation types require large population sub-groups and common measures of mental health.
AimWe hypothesise: (1) we will detect differences in the prevalence of Common Mental Disorder (CMD) across occupational groupings; and (2) risk of CMD across occupation types is moderated by family demands.
MethodsUsing linked administrative data we examine CMD among the Northern Ireland (NI) adult population across Standard Occupational Classifications (SOCs). We also examine the influence of socio-demographic, socio-economic and health-related variables. Data is accessed through the Administrative Data Research Centre NI (ADRC-NI) and comprises the individual and household 2011 Census; Land and Properties Services data; Enhanced Prescribing Database and Multiple Deprivation Measures.
ResultsExamination of nine major SOC groups shows the prevalence of any self-reported (SR) mental health condition was highest among 'elementary trades and related occupations' (24.63%) followed by 'process, plant and machine operatives' (23.65%). The risk of mental ill health among these groups remained elevated for both men and women after controlling for age, sex, marital status and educational attainment. Analyses based on the 90 sub-minor SOC groups shows that 'textiles and garments trades' workers had the highest prevalence of a SR mental health condition (36.15%). Logistic regression analyses shows that individuals with dependent children and informal caregiving responsibilities had lower risk of a SR mental health condition (OR=0.75, CI=0.73, 0.76 and OR=0.81, CI=0.79, 0.82 respectively).
ConclusionResults presented in this abstract are based on preliminary analyses using self-reported mental health. Further analyses based on mental health prescription data will subsequently be undertaken and presented at the ADR conference.
In recent years, social exclusion has gained the attention of governments around the world. This paper reports on a qualitative study involving 27 young men aged 14–19 years experiencing particular forms of exclusion in the context of Northern Irish society. The study used a focus group methodology to elicit their views with the aim of exploring both emotional and psychological needs and the structural factors that may contribute to their experiences of social exclusion. The findings reveal a range of unmet social and psychological needs, the impact of sectarianism and segregation, and a paucity of support systems in place. The paper concludes by making recommendations about how policy‐makers and practitioners could find more imaginative ways of engaging such vulnerable young men to reduce social exclusion.
