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      Guidelines for the public on how to provide mental health first aid: narrative review

      , PhD, DSC, , MPsych (Clinical)

      BJPsych Open

      Cambridge University Press

      Alcohol disorders, anxiety disorders, self-harm, depressive disorders, drugs of dependence disorders

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          Expert-consensus guidelines have been developed for how members of the public should assist a person with a mental health problem or in a mental health crisis.


          This review aimed to examine the range of guidelines that have been developed and how these have been implemented in practice.


          A narrative review was carried out based on a systematic search for literature on the development or implementation of the guidelines.


          The Delphi method has been used to develop a wide range of guidelines for English-speaking countries, Asian countries and a number of other cultural groups. The primary implementation has been through informing the content of training courses.


          Further work is needed on guidelines for low- and middle-income countries.

          Declaration of interest

          A.F.J. is an unpaid member of the Board of Mental Health First Aid International (trading as Mental Health First Aid Australia), which is a not-for-profit organisation.

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          Most cited references 72

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          Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis.

          Duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcomes of schizophrenia. Long DUP as a predictor of poor short-term outcome has been addressed in previous meta-analyses, but the long-term effects of DUP remain unclear.
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            Social bonds and posttraumatic stress disorder.

            Retrospective and prospective studies consistently show that individuals exposed to human-generated traumatic events carry a higher risk of developing Posttraumatic Stress Disorder (PTSD) than those exposed to other kinds of events. These studies also consistently identify perceptions of social support both before and after a traumatic event as an important factor in the determining vulnerability to the development of PTSD. We review the literature on interpersonal traumas, social support and risk for PTSD and integrate findings with recent advances in developmental psychopathology, attachment theory and social neuroscience. We propose and gather evidence for what we term the social ecology of PTSD, a conceptual framework for understanding how both PTSD risk and recovery are highly dependent on social phenomena. We explore clinical implications of this conceptual framework.
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              Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey.

              Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination. In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data. 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coefficient 0·20 [95% CI 0·09-0·32], p=0·001); at least one lifetime psychiatric hospital admission (0·29 [0·15-0·42], p=0·001); poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01-0·19], p=0·032; unpaid employed 0·34 [0·09-0·60], p=0·007; looking for a job 0·26 [0·09-0·43], p=0·002; and unemployed 0·22 [0·03-0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression; p<0·0001). Anticipated discrimination is not necessarily associated with experienced discrimination because 147 (47%) of 316 participants who anticipated discrimination in finding or keeping a job and 160 (45%) of 353 in their intimate relationships had not experienced discrimination. Discrimination related to depression acts as a barrier to social participation and successful vocational integration. Non-disclosure of depression is itself a further barrier to seeking help and to receiving effective treatment. This finding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the effects of stigma when it is already established. European Commission, Directorate General for Health and Consumers, Public Health Executive Agency. Copyright © 2013 Elsevier Ltd. All rights reserved.

                Author and article information

                BJPsych Open
                BJPsych Open
                BJPsych Open
                Cambridge University Press (Cambridge, UK )
                November 2018
                22 October 2018
                : 4
                : 6
                : 427-440
                Professorial Fellow, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne , Australia
                Research Assistant, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne , Australia
                Author notes
                Correspondence: Anthony F. Jorm, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne , 207 Bouverie Street, Carlton 3010, Australia. Email: ajorm@
                S2056472418000583 00058
                © The Royal College of Psychiatrists 2018

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

                Page count
                Figures: 1, Tables: 6, References: 94, Pages: 14


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