Variability of medical practice in the face of emerging mental health problems
Keywords:
Medical variability, mental health, emerging issues, Primary Health CareAbstract
Introduction: Variability in mental health medical practice is a growing phenomenon that reflects the current challenges of providing equitable, quality care in the face of the emergence of new disorders linked to social, technological, and environmental factors.
Objective: To analyze the current status of mental health medical practice and the factors that explain its variability in the face of emerging problems.
Material and Methods: A narrative review was conducted. Databases such as PubMed, Scopus and SciELO were consulted using descriptors such as mental health, medical variability, and emerging problems. Filters were applied by language (Spanish and English), full-text access, and publications between 2014 and 2024. Of the 89 references reviewed, 37 were selected for their thematic relevance, scientific rigor, and applicability to the study.
Results: Key factors contributing to variability were identified: cultural and regional differences, diverse professional training, unequal access to treatments, uneven adoption of technologies, disparities in health policies, and a persistent gap between scientific evidence and clinical practice.
Conclusions: Variability, although partly necessary to adapt care to specific contexts, can generate inequities when it is not aligned with the best available evidence. Promoting flexible standardization, strengthening ongoing training, and designing health policies that guarantee equitable access are essential to improve mental health outcomes and reduce disparities in care.
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References
1. Momen NC, Plana O, Agerbo E, Benros ME, Børglum AD, Christensen MK, et al. Association between mental disorders and subsequent medical conditions. N Engl J Med [Internet]. 2020 [Citado 19/07/2024];382(18):1721-31. Disponible en: https://doi.org/10.1056/NEJMoa1915784
2. Volovik S, Krupa T, Bloch Y, Lipskaya L. Occupational intervention in mental health hospitals: study of contextual impact. Scand J Occup Ther [Internet]. 2023 [Citado 19/07/2024];30(2):137-47. Disponible en: https://doi.org/10.1080/11038128.2022.2076734
3. Wu Y, Wang L, Tao M, Cao H, Yuan H, Ye M, et al. Changing trends in the global burden of mental disorders from 1990 to 2019 and predicted levels in 25 years. Epidemiol Psychiatr Sci [Internet]. 2023 [Citado 19/07/2024];32. Disponible en: https://doi.org/10.1017/S2045796023000756
4. Blæhr EE, Gallo Córdoba B, Skipper N, Søgaard R. Variation in psychiatric hospitalisations: a multiple-membership multiple-classification analysis. Int J Environ Res Public Health [Internet]. 2024 [Citado 19/07/2024];21(8):973. Disponible en: https://doi.org/10.3390/ijerph21080973
5. Moore G, Campbell M, Copeland L, Craig P, Movsisyan A, Hoddinott P, et al. Adapting interventions to new contexts—the ADAPT guidance. BMJ [Internet]. 2021 [Citado 19/07/2024];374:n1679. Disponible en: https://doi.org/10.1136/bmj.n1679
6. Humane S, Khaire P. Evidence-based practice in psychiatric nursing. Asian J Nurs Educ Res [Internet]. 2023 [Citado 19/07/2024];13(2):2349-996. Disponible en: https://doi.org/10.52711/2349-2996.2023.00024
7. Arensman E, Scott V, De Leo D, Pirkis J. Suicide and suicide prevention from a global perspective. Crisis [Internet]. 2020 [Citado 19/07/2024];41(Suppl 1). Disponible en: https://doi.org/10.1027/0227-5910/a000664
8. Charlson F, van Ommeren M, Flaxman A, Cornett J, Whiteford H, Saxena S. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet [Internet]. 2019 [Citado 19/07/2024];394(10194):240-48. Disponible en: https://doi.org/10.1016/S0140-6736(19)30934-1
9. Nguyen T, Seiler N, Brown E, O'Donoghue B. The effect of clinical practice guidelines on prescribing practice in mental health: a systematic review. Psychiatry Res [Internet]. 2020 [Citado 19/07/2024];284:112671. Disponible en: https://doi.org/10.1016/j.psychres.2019.112671
10. GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry [Internet]. 2022 [Citado 19/07/2024];9(2):137-50. Disponible en: https://doi.org/10.1016/S2215-0366(21)00395-3
11. COVID-19 Mental Disorders Collaborators. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet [Internet]. 2021 [Citado 19/07/2024];398(10312):1700-12. Disponible en: https://doi.org/10.1016/S0140-6736(21)02143-7
12. Silva J, Lapadula C, Westfall JM, Gaona G, De Lusignan S, Kristiansson RS, et al. Effect of the COVID-19 pandemic on mental health visits in primary care: an interrupted time series analysis from nine INTRePID countries. E Clinical Medicine [Internet]. 2024 [Citado 19/07/2024];70:102533. Disponible en: https://doi.org/10.1016/j.eclinm.2024.102533
13. Rawaf S, Allen LN, Stigler FL, Kringos D, Quezada Yamamoto H, Van Weel C, et al. Lessons on the COVID-19 pandemic, for and by primary care professionals worldwide. Eur J Gen Pract [Internet]. 2020 [Citado 19/07/2024];26(1):129-33. Disponible en: https://doi.org/10.1080/13814788.2020.1820479
14. Søvold LE, Naslund JA, Kousoulis AA, Saxena S, Qoronfleh MW, Grobler C, et al . Prioritizing the mental health and well-being of healthcare workers: an urgent global public health priority. Front Public Health [Internet]. 2021 [Citado 19/07/2024];9:679397. Disponible en: https://doi.org/10.3389/fpubh.2021.679397
15. Marx W, Manger SH, Blencowe M. Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce. World J Biol Psychiatry [Internet]. 2023 [Citado 19/07/2024];24(5):333-86. Disponible en: https://doi.org/10.1080/15622975.2022.2112074
16. Okumura Y. Geographical variation in psychiatric admissions among recipients of public assistance. J Epidemiol [Internet]. 2019 [Citado 19/07/2024];29(7):264-71. Disponible en: https://doi.org/10.2188/jea.JE20180066
17. Armstrong C. Mobile health provider training: results and lessons learned from year four of training on core competencies for mobile health in clinical care. J Technol Behav Sci [Internet]. 2019 [Citado 19/07/2024];4:86–92. Disponible en: https://doi.org/10.1007/s41347-019-00089-8
18. Torous J. A path towards progress: lessons from the hard things about digital mental health. World Psychiatry [Internet]. 2022 [Citado 19/07/2024];21(3):419-20. Disponible en: https://doi.org/10.1002/wps.21003
19. Schueller SM, Touros J. Scaling evidence-based treatments through digital mental health. Am Psychol [Internet]. 2020 [Citado 19/07/2024];75(8):1093-104. Disponible en: https://doi.org/10.1037/amp0000654
20. Shelby-James T, Rattray M, Raymond G, Reed R. Capacity building for mental health services: methodology and lessons learned from the Partners in Recovery initiative. Aust J Prim Health [Internet]. 2023 [Citado 19/07/2024];30. Disponible en: https://doi.org/10.1071/PY23003
21. Fu Z, Burger H, Arjadi R, Bockting CLH. Effectiveness of digital psychological interventions for mental health problems in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Psychiatry [Internet]. 2020 [Citado 19/07/2024];7(10):851-64. Disponible en: https://doi.org/10.1016/S2215-0366(20)30256-X
22. Chan CS, Wong CYF, Yu BYM, Hui VKY, Ho FYY, Cuijpers P. Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: a parallel-group randomized controlled trial. Psychol Med [Internet]. 2023 [Citado 19/07/2024];53(5):1799-813. Disponible en: https://doi.org/10.1017/S0033291721003421
23. García A, Girón F, Rosselli D. La integración de la inteligencia artificial en la atención médica: desafíos éticos y de implementación. Univ Med [Internet]. 2023 [Citado 19/07/2024];64(3). Disponible en: https://doi.org/10.11144/Javeriana.umed64-3.inte
24. Cummins N, Schuller BW. Five crucial challenges in digital health. Front Digit Health [Internet]. 2020 [Citado 19/07/2024];2:38. Disponible en: https://doi.org/10.3389/fdgth.2020.536203
25. Patel V, Saxena S, Lund C. Transforming mental health systems globally: principles and policy recommendations. Lancet [Internet]. 2023 [Citado 19/07/2024];402(10402):656-66. Disponible en: https://doi.org/10.1016/S0140-6736(23)00918-2
26. Jack HE, Merritt C, Medhin G. Developing sustainable capacity-building in mental health research: implementation outcomes of training of trainers in systematic reviewing. Glob Health Action [Internet]. 2020 [Citado 19/07/2024];13(1):1715325. Disponible en: https://doi.org/10.1080/16549716.2020.1715325
27. McGinty B. The future of public mental health: challenges and opportunities. Milbank Q [Internet]. 2023 [Citado 19/07/2024];101(S1):532-51. Disponible en: https://doi.org/10.1111/1468-0009.12622
28. Bucci S, Berry N, Morris R. "They are not hard-to-reach clients. We have just got hard-to-reach services." Staff views of digital health tools in specialist mental health services. Front Psychiatry [Internet]. 2019 [Citado 19/07/2024];10:344. Disponible en: https://doi.org/10.3389/fpsyt.2019.00344
29. Cliffe B, Croker A, Denne M, Stallard P. Clinicians' use of and attitudes towards technology to provide and support interventions in child and adolescent mental health services. Child Adolesc Ment Health [Internet]. 2020 [Citado 19/07/2024];25(2):95-101. Disponible en: https://doi.org/10.1111/camh.12362
30. Trubey R, Evans R, McDonald S, Noyes J, Robling M, Willis S, et al. Effectiveness of mental health and wellbeing interventions for children and young people in foster, kinship, and residential care: systematic review and meta-analysis. Trauma Violence Abuse [Internet]. 2024 [Citado 19/07/2024];1-16. Disponible en: https://doi.org/10.1177/15248380241227987
31. Torous J, Jän K, Rauseo N, Firth J. Digital mental health and COVID-19: using technology today to accelerate the curve on access and quality tomorrow. JMIR Ment Health [Internet]. 2020 [Citado 19/07/2024];7(3). Disponible en: https://doi.org/10.2196/18848
32. Flaherty H. Bridging the gap between research and practice: a discussion about how to integrate evidence-based interventions in clinical practice through education. JPTS [Internet]. 2020 [Citado 19/07/2024];17(2):25-41. Disponible en: https://journals.whitingbirch.net/index.php/JPTS/article/view/1302
33. Lipskaya L, Krupa T. Closing the gap: from research to practice in mental health interventions. Int J Environ Res Public Health [Internet]. 2023 [Citado 19/07/2024];20(3):2141. Disponible en: https://doi.org/10.3390/ijerph20032141
34. Torous J, Bucci S, Bell IH. The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry [Internet]. 2021 [Citado 19/07/2024];20(3):318-35. Disponible en: https://doi.org/10.1002/wps.20883
35. Smith KA, Blease C, Faurholt-Jepsen M. Digital mental health: challenges and next steps. BMJ Ment Health [Internet]. 2023 [Citado 19/07/2024];26(1). Disponible en: https://doi.org/10.1136/bmjment-2023-300670
36. Thornicroft G, Sunkel C, Alikhon Aliev A. The Lancet Commission on ending stigma and discrimination in mental health. Lancet [Internet]. 2022 [Citado 19/07/2024];400(10361):1438-80. Disponible en: https://doi.org/10.1016/S0140-6736(22)01470-2
37. Martinez N, Dasgupta I, Carter A. Ethics of digital mental health during COVID-19: crisis and opportunities. JMIR Ment Health [Internet]. 2020 [Citado 19/07/2024];7(12). Disponible en: https://doi.org/10.2196/23776
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