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      Redevelopment of mental health first aid guidelines for supporting someone experiencing a panic attack: a Delphi study

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          Abstract

          Background

          Panic attacks and panic disorder can have a major impact on the mental health and wellbeing of those who experience them. People with recurrent panic attacks have increased odds of developing a mental disorder and of worsening the course of existing mental disorders. Early intervention efforts at the time that a panic attack occurs might reduce or prevent some of these associated negative outcomes. Expert consensus guidelines for high income Western countries on how to provide mental health first aid for panic attacks were published in 2009. The present study aims to redevelop these guidelines to ensure content reflects current evidence and best practice.

          Methods

          The Delphi consensus method was used to determine which helping strategies should be included in the redeveloped guidelines. A survey with items on how to assist someone who is having a panic attack was developed using the 2009 guidelines and a systematic search of grey and academic literature. Panellists with lived experience and professional experience rated these items to determine which helping statements should be included in the guidelines.

          Results

          Thirty panellists completed all three surveys. Panellists rated 158 statements, with 83 statements meeting the criteria for inclusion in the redeveloped guidelines. The endorsed statements covered: what the first aider should know about panic attacks, what they should do if they think someone is having a panic attack, what they should do if they are uncertain whether the person is having a panic attack, what they should say and do if they know the person is having a panic attack and what they should do when the panic attack has ended.

          Conclusion

          This study has resulted in a more comprehensive set of guidelines than the original version, with the endorsement of 83 helping actions, compared to 27 previously. The redeveloped guidelines provide greater detail on recognising the signs of a panic attack, providing initial assistance, communicating with someone experiencing a panic attack and supporting them to seek appropriate professional help if it is needed. The guidelines will be used in future updates of Mental Health First Aid training courses.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s40359-022-00843-3.

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          Most cited references29

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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.

          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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            Epidemiology of anxiety disorders in the 21st century

            Anxiety disorders, including panic disorder with or without agoraphobia, generalized anxiety disorder, social anxiety disorder, specific phobias, and separation anxiety disorder, are the most prevalent mental disorders and are associated with immense health care costs and a high burden of disease. According to large population-based surveys, up to 33.7% of the population are affected by an anxiety disorder during their lifetime. Substantial underrecognition and undertreatment of these disorders have been demonstrated. There is no evidence that the prevalence rates of anxiety disorders have changed in the past years. In cross-cultural comparisons, prevalence rates are highly variable. It is more likely that this heterogeneity is due to differences in methodology than to cultural influences. Anxiety disorders follow a chronic course; however, there is a natural decrease in prevalence rates with older age. Anxiety disorders are highly comorbid with other anxiety disorders and other mental disorders.
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              Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.

              Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.
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                Author and article information

                Contributors
                kathrync@mhfa.com.au
                alyssiar@mhfa.com.au
                nreavley@unimelb.edu.au
                ajorm@unimelb.edu.au
                bettyakitchener@gmail.com
                clairek@mhfa.com.au
                ajmorgan@unimelb.edu.au
                kathybond@mhfa.com
                fairliec@mhfa.com.au
                Journal
                BMC Psychol
                BMC Psychol
                BMC Psychology
                BioMed Central (London )
                2050-7283
                27 May 2022
                27 May 2022
                2022
                : 10
                : 136
                Affiliations
                [1 ]Mental Health First Aid Australia, Parkville, VIC Australia
                [2 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Centre for Mental Health, Melbourne School of Population and Global Health, , University of Melbourne, ; Parkville, VIC Australia
                [3 ]Kitchener Consulting, Melbourne, Australia
                Article
                843
                10.1186/s40359-022-00843-3
                9145494
                35624500
                ff6b9d19-76f8-4388-95ee-99765608e78b
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 24 February 2022
                : 17 May 2022
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                mental health first aid,panic attack,panic disorder,prevention,helping behaviour,mental illness,mental health,mental health crisis,delphi method,expert consensus,community guidelines

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