Papers by Petra C Gronholm
Frontiers in Psychiatry
BackgroundThe month of Ramadan, due to its changes in social rhythms, can seriously affect the co... more BackgroundThe month of Ramadan, due to its changes in social rhythms, can seriously affect the course of bipolar disorder (BD). Therefore, psychiatrists sometimes find it necessary to discourage Ramadan practices, especially fasting, although taking part in this practice can give a sense of belonging and accomplishment to patients. Research on this subject is limited.AimThe aim of the present work was to explore: (i) religious practices with special attention to Ramadan before and after the onset of BD, (ii) the perceptions and behaviors related to not fasting during Ramadan in patients with BD and their families’ attitudes, (iii) religiosity and self-stigmatization and their relationships with religious practices, and (iv) the doctor-patient relationship around fasting.MethodsWe conducted a retrospective, cross-sectional and descriptive study in clinically stabilized patients with BD in a public mental hospital and in a private psychiatric practice in Tunis, Tunisia. Socio-demograp...
BACKGROUND The COVID-19 pandemic has shed light on fractures in health care systems worldwide and... more BACKGROUND The COVID-19 pandemic has shed light on fractures in health care systems worldwide and continues to have a significant impact, particularly in relation to the health care workforce. Frontline staff have been exposed to unprecedented strain, and delivering care during the pandemic has affected their safety, mental health, and well-being. OBJECTIVE This study aimed to explore the experiences of health care workers (HCWs) delivering care in the United Kingdom during the COVID-19 pandemic to understand their well-being needs, experiences, and strategies used to maintain well-being (at individual and organizational levels). METHODS We analyzed 94 telephone interviews with HCWs and 2000 tweets about HCWs’ mental health during the first year of the COVID-19 pandemic. RESULTS The results were grouped under 6 themes: redeployment, clinical work, and sense of duty; well-being support and HCW’s coping strategies; negative mental health effects; organizational support; social network and support; and public and government support. CONCLUSIONS These findings demonstrate the need for open conversations, where staff’s well-being needs and the strategies they adopted can be shared and encouraged, rather than implementing top-down psychological interventions alone. At the macro level, the findings also highlighted the impact on HCW’s well-being of public and government support as well as the need to ensure protection through personal protective equipment, testing, and vaccines for frontline workers.
Social Psychiatry and Psychiatric Epidemiology, Jun 26, 2023
Purpose This study examines the association between mental health problems in adolescence and gen... more Purpose This study examines the association between mental health problems in adolescence and general practice (GP) costs during adulthood up to age 50 in the UK. Methods We conducted secondary analyses of three British birth cohorts (individuals born in single weeks in 1946, 1958 and 1970). Data for the three cohorts were analysed separately. All respondents who participated in the cohort studies were included. Adolescent mental health status was assessed in each cohort using the Rutter scale (or, for one cohort, a forerunner of that scale) completed in interviews with parents and teachers when cohort members were aged around 16. Presence and severity of conduct and emotional problems were modelled as independent variables in two-part regression models in which the dependent variable was costs of GP services from data collection sweeps up to mid-adulthood. All analyses were adjusted for covariates (cognitive ability, mother's education, housing tenure, father's social class and childhood physical disability). Results Adolescent conduct and emotional problems, particularly when coexisting, were associated with relatively high GP costs in adulthood up to age 50. Associations were generally stronger in females than males. Conclusion Associations between adolescent mental health problems and annual GP cost were evident decades later, to age 50, suggesting that there could be significant future savings to healthcare budgets if rates of adolescent conduct and emotional problems could be reduced. Trial registration Not applicable.
Epidemiology and Psychiatric Sciences, 2021
Aims. To develop recommendations for strategies and interventions to reduce stigma and discrimina... more Aims. To develop recommendations for strategies and interventions to reduce stigma and discrimination related to coronavirus disease 2019 (COVID-19), through reviewing and synthesising evidence in relation to COVID-19 and other disease outbreaks and infectious/ stigmatised conditions from systematic reviews and primary studies and recommendations from additional materials. Methods. Rapid review, drawing on the World Health Organization's (WHO) methodology for developing interim guidelines during health emergencies. PubMed/MEDLINE, PsycINFO, Cochrane Central and Campbell Collaboration searched up to mid-April 2020. Searches were supplemented by reference-searching and expert recommendations. Searches were designed to identify: (1) systematic reviews (<10 years), or (2) primary intervention studies (no date limit) reporting evidence on anti-stigma interventions (in relation to COVID-19 or other infectious/stigmatised conditions) or (3) additional relevant materials. Data were extracted on population, intervention, outcome and results. These data were compiled into evidence summary tables and narrative overviews. Recommendations on strategies for COVID-19 stigma-reduction were developed using the WHO 'Evidence to Decision' framework approach. The review protocol was registered with PROSPERO (registration ID: CRD42020177677). Results. The searches identified a total of 4150 potentially relevant records, from which 12 systematic reviews and 29 additional articles were included. Overarching considerations and specific recommendations focus on: (1) language/words used in relation to COVID-19 and affected people; (2) media/journalistic practices; (3) public health interventions; (4) targeted public health interventions for key groups and (5) involving communities and key stakeholders. Conclusions. These recommendations represent the first consolidated evidence-based guidance on stigma and discrimination reduction in relation to COVID-19. Mitigating the impact of stigma is critical in reducing distress and negative experiences, and strengthening communities' resolve to work together during exceptional circumstances. Ultimately, reducing stigma helps addressing structural inequalities that drive marginalisation and exacerbate both health risks and the impact of stigma. Administrations and decision makers are urged to consider integrating these recommendations into the ongoing COVID-19 response.
Schizophrenia Bulletin, Apr 1, 2018
and need for care than the 'psychosis risk' label. Similarly, in the second study, the 'reality-t... more and need for care than the 'psychosis risk' label. Similarly, in the second study, the 'reality-testing loss' label elicited higher appraisals of self-image, hope, likelihood of seeking help, and importance of providing care than the 'attenuated psychosis' label. In both studies, no effects were found for symptom severity. Discussion: These pilot results provide first empirical support for the social and clinical potential of 'high-risk health' formulations in minimizing the potential stigmatizing harms of 'at-risk' diagnostic labels and improving help-seeking behaviors. If addition, they lay the theoretical and methodological foundation for future studies that will replicate and extend the above findings using more ecologically valid manipulations (e.g., experimental intake meeting clips) among individuals at high risk and their families.
Epidemiology and Psychiatric Sciences, 2022
Indirect social contact interventions to reduce mental health-related stigma in low-and middle-in... more Indirect social contact interventions to reduce mental health-related stigma in low-and middle-income countries: systematic review. Epidemiology and Psychiatric Sciences 31, e79, 1-10.
Social Science & Medicine, Aug 1, 2022
Epidemiology and Psychiatric Sciences, 2022
Mental health stigma and discrimination are global problems, and their reduction is recognised as... more Mental health stigma and discrimination are global problems, and their reduction is recognised as an important public health priority. Involving celebrities in stigma reduction is increasingly common. This Editorial considers the impact of celebrity disclosure on mental health-related stigma; that is, whether and how a famous person openly speaking about their experience of mental health conditions can reduce stigma. Potential explanations for how celebrity mental health disclosures can influence mental health-related knowledge, attitudes and behaviours are outlined, followed by an overview of evidence on how celebrity disclosure operates to reduce stigma. Considering the available evidence, we provide a number of conclusions and recommendations for how celebrities can effectively be involved in antistigma efforts, and what considerations this requires. It is fair to say that celebrity disclosures can support stigma-reduction efforts through increasing the public's awareness of mental health, modelling behaviour and generating openness on speaking about mental health problems, and on seeking help when needed. However, whether celebrity disclosure achieves changes in mental health stigma-related knowledge, attitudes and behaviours depends on the extent to which there is a match between the attributes of the famous person, the content shared in their disclosure narrative and the intended audience of the message. Further research is needed on all these questions to better understand how to successfully utilise the potentially huge power of celebrity disclosure in large-scale anti-stigma efforts. 'Open Government Licence' or 'Creative Commons Attribution No-derivatives (CC BY-ND) licence' may be stated instead) to any Author Accepted Manuscript version arising.
Implementation Science
Background There are increasing efforts for the integration of mental health services into primar... more Background There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. Design In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted ...
BackgroundSubstantial evidence has highlighted the importance of considering healthcare workers’ ... more BackgroundSubstantial evidence has highlighted the importance of considering healthcare workers’ (HCW) mental health during the COVID-19 pandemic, and several organisations have issued guidelines with recommendations. However, the definition of wellbeing and the evidence-base behind such guidelines remains unclear.ObjectivesAssessing the applicability of wellbeing guidelines in practice; identifying unaddressed HCWs’ needs; and providing recommendations for supporting frontline staff during the current and future pandemics.Methods and DesignThis paper discusses the findings of a qualitative study based on interviews with frontline healthcare staff in the UK and examines them in relation to a rapid review of wellbeing guidelines developed in response to the COVID-19 pandemic.Results14 guidelines were included in the rapid review and 33 interviews with HCWs were conducted in the qualitative study. As a whole, the guidelines placed greater emphasis on wellbeing at an individual level, ...
Epidemiology and Psychiatric Sciences, 2022
Aims Stigma related to mental disorders is a barrier to quality mental healthcare. This scoping r... more Aims Stigma related to mental disorders is a barrier to quality mental healthcare. This scoping review aimed to synthesise literature on stigma related to mental disorders in Nepal to understand stigma processes. The anthropological concept of ‘what matters most’ to understand culture and stigma was used to frame the literature on explanatory models, manifestations, consequences, structural facilitators and mitigators, and interventions. Methods We conducted a scoping review with screening guided by the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR). A structured search was done using three international databases (PsycINFO, Medline and Web of Science), one Nepali database (NepJol) and cross-referencing for publications from 1 January 2000 through 24 June 2020. The search was repeated to include structural stigma-related terms. Quality of quantitative studies was assessed using the Systematic Assessment of Quality in Obse...
Journal of Medical Internet Research
Background The COVID-19 pandemic has shed light on fractures in health care systems worldwide and... more Background The COVID-19 pandemic has shed light on fractures in health care systems worldwide and continues to have a significant impact, particularly in relation to the health care workforce. Frontline staff have been exposed to unprecedented strain, and delivering care during the pandemic has affected their safety, mental health, and well-being. Objective This study aimed to explore the experiences of health care workers (HCWs) delivering care in the United Kingdom during the COVID-19 pandemic to understand their well-being needs, experiences, and strategies used to maintain well-being (at individual and organizational levels). Methods We analyzed 94 telephone interviews with HCWs and 2000 tweets about HCWs’ mental health during the first year of the COVID-19 pandemic. Results The results were grouped under 6 themes: redeployment, clinical work, and sense of duty; well-being support and HCW’s coping strategies; negative mental health effects; organizational support; social network...
BJPsych Open
Background Protecting all human rights of people with mental health conditions is globally import... more Background Protecting all human rights of people with mental health conditions is globally important. However, to facilitate practical implementation of rights, it is often necessary to decide which of these rights should be given priority, especially when they conflict with each other. Aims The aim of the Priorities of Human Rights and Mental Health (PHRAME) project is to develop a replicable approach to establish a proposed set of high-priority human rights of people with mental health conditions, to facilitate practical decision-making and implementation of such rights. Method A two-stage Delphi-style study with stakeholders was conducted to generate a list of key rights of people with mental health conditions, and rank priorities among these rights in terms of feasibility, urgency and overall importance. Results The stakeholders in this study consistently ranked three rights as top priorities: (a) the right to freedom from torture, cruel inhuman treatment and punishment; (b) the...
International Journal of Mental Health Systems
There is increasing attention to the impacts of stigma and discrimination related to mental healt... more There is increasing attention to the impacts of stigma and discrimination related to mental health on quality of life and access to and quality of healthcare. Effective strategies for stigma reduction exist, but most evidence comes from high-income settings. Recent reviews of stigma research have identified gaps in the field, including limited cultural and contextual adaptation of interventions, a lack of contextual psychometric information on evaluation tools, and, most notably, a lack of multi-level strategies for stigma reduction. The Indigo Partnership research programme will address these knowledge gaps through a multi-country, multi-site collaboration for anti-stigma interventions in low- and middle-income countries (LMICs) (China, Ethiopia, India, Nepal, and Tunisia). The Indigo Partnership aims to: (1) carry out research to strengthen the understanding of mechanisms of stigma processes and reduce stigma and discrimination against people with mental health conditions in LMICs...
Background: Mental health and other health professionals working in mental health care may contri... more Background: Mental health and other health professionals working in mental health care may contribute to the experiences of stigma and discrimination among mental health service users, but can also help reduce the impact of stigma on service users. However the few studies of interventions to equip such professionals to be anti-stigma agents those took place in High-Income Countries. This study assesses the feasibility, potential effectiveness and costs of Responding to Experienced and Anticipated Discrimination training for health professionals working in mental health care (READ-MH) across Low- and Middle-Income Countries (LMICs). Methods: This is an uncontrolled pre-post mixed methods feasibility study of READ-MH training at seven sites across five LMICs (China, Ethiopia, India, Nepal, and Tunisia). Outcome measures: knowledge based on course content; attitudes to working to address the impact of stigma on service users; and skills in responding constructively to service users’ re...
The Cambridge Handbook of Stigma and Mental Health
Strategy modulates spatial perspective-taking: evidence
Epidemiology and Psychiatric Sciences, 2020
Aims To identify and categorise core components of effective stigma reduction interventions in th... more Aims To identify and categorise core components of effective stigma reduction interventions in the field of mental health in low- and middle-income countries (LMICs) and compare these components across cultural contexts and between intervention characteristics. Methods Seven databases were searched with a strategy including four categories of terms ('stigma’, ‘mental health’, ‘intervention’ and ‘low- and middle-income countries’). Additional methods included citation chaining of all papers identified for inclusion, consultation with experts and hand searching reference lists from other related reviews. Studies on interventions in LMICs aiming to reduce stigma related to mental health with a stigma-related outcome measure were included. All relevant intervention characteristics and components were extracted and a quality assessment was undertaken. A ‘best fit’ framework synthesis was used to organise data, followed by a narrative synthesis. Results Fifty-six studies were included...
Epidemiology and Psychiatric Sciences, 2019
Aims This review aims to understand the scope of the literature regarding mental health-related m... more Aims This review aims to understand the scope of the literature regarding mental health-related microaggressions towards people affected by mental health problems. Methods A scoping review was conducted to explore this question. Four electronic health-oriented databases were searched alongside Google Scholar. As per scoping review principles, the inclusion criteria were developed iteratively. The results of included studies were synthesised using a basic narrative synthesis approach, utilising principles of thematic analysis and thematic synthesis where appropriate. Results A total of 1196 records were identified, of which 17 met inclusion criteria. Of these, 12 were peer-reviewed journal articles, three were research degree theses and two were book chapters. Six included empirical studies were qualitative, four were quantitative and two employed a mixed-methods design. Within these, five qualitative studies aimed to describe the nature of mental health microaggressions experienced ...
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Papers by Petra C Gronholm