Multi-Modal Ensemble Framework for Mental Health Disorder Prediction: A Novel Machine Learning Approach

The last two decades have witnessed a growing acknowledgment of the importance of research on mental health in the global health context. The 1995 edited volume, World Mental Health [1], the 1996 publication of the Global Burden of Disease Study [2], and the 2001 World Health Report [3] powerfully utilized mental health data or underscored the role of research in achieving gains in mental health around the world. By 2007, the World Health Organization and the Global Forum for Health Research released their report on research capacity for mental health, demonstrating the dearth of mental health research from low- and middle-income countries, in particular, as well as the need to bridge the gap between research, practice, and policy [4]. That same year, the Lancet special issue on global mental health galvanized the global mental health community, outlining concrete actions to advance the field [5]. The series Call to Action underscored the importance of research as a means to expand the global evidence base and to make the case for mental health care delivery reform, especially in low-and middle-income countries (LMICs) [5]. At the time, however, medical students and residents from high-, middle-, and low-income countries, alike, would have noted a dearth of funding to support research training focused on global mental health themes. Despite this, by 2009, new global health programs at universities were rapidly appearing in the USA and providing more opportunities for training in global health [6], but few had well-developed mental health components—either research or clinically focused. At the National Institute of Mental Health (NIMH), a reevaluation of the institute’s role in global health research was also underway. By mid-2009, NIMH began reorganizing the Office for Special Populations and the Office of Global Mental Health to create the Office for Research on Disparities and Global Mental Health (ORDGMH) in 2010. Consistent with the NIMH mission, the new office underscored (1) the critical need to mount an inclusive global effort to expand research—and the capacity to conduct research—on preventing and treating mental illness, (2) the centrality of eliminating disparities as part and parcel of this effort, and (3) the value of recognizing that local contexts around the globe share commonalities that can provide insights into equitably reducing the suffering associated with mental illness. An explicit goal of ORDGMH was to create a research career path in global mental health for US investigators, while also supporting research capacity building in low- and middle-income countries as a route to building high-quality collaborative research. To achieve this goal, ORDGMH expanded collaborations with the Fogarty International Center (FIC)—the NIH center tasked with supporting and facilitating global health research and research training—and, where indicated, developed new targeted initiatives for research capacity development in mental health. In this article, we briefly describe NIMH activities in support of global mental health research training and future directions for research training in global mental health.

The fields of cultural psychiatry and global mental health have distinct lineages but share domains of interest. The movement for global mental health has been successful in making mental health a priority in global health and securing grants to study interventions in low- and middle-income countries (LMICs). Lessons learned from global mental health efforts in LMICs are relevant to addressing health disparities and improving care for vulnerable populations in high-income countries. These interventions stress community collaboration in designing and delivering mental health care, integration of mental health into primary care settings, and engagement of trained and supervised nonspecialist health workers in care delivery. The framework of structural competence provides a path forward for psychiatry to collaborate with community organizations to adapt global interventions to local settings. [ Psychiatr Ann. 2018;48(3):149–153.]

PurposeThe Patient-Reported Outcomes Measurement and Information System (PROMIS®): includes the PROMIS-29 physical and mental health summary and the PROMIS global physical and mental health scores. It is unknown how these scores coincide with one another. This study examines whether the scores yield similar or different information.MethodsThe PROMIS-29 and the PROMIS global health items were administered to 5804 adults from Amazon’s Mechanical Turk (MTurk) in 2021–2022 and to 4060 adults in the Ipsos KnowledgePanel (KP) in 2022.ResultsThe median age of those in MTurk (KP) was 36 (54) and 53% (50%) were male. Mean T-scores on the PROMIS-29 and PROMIS global physical health scales were similar, but PROMIS global mental health was 3–4 points lower than the PROMIS-29 mental health summary score. Product-moment correlations ranged from 0.69 to 0.81 between the PROMIS-29 physical health and PROMIS global physical health scales and 0.56–0.69 between the mental health scales. Multi-trait multimethod analyses indicated that only a small proportion of the correlations between the two methods of measuring mental health were significantly more highly correlated with one another than correlations between physical and mental health.ConclusionsPROMIS-29 and PROMIS global mental health scales provide different information and, therefore, study conclusions may vary depending on which measure is used. Interpretation of results needs to consider that the PROMIS-29 mental health scale is a weighted combination of specific domains while the PROMIS global mental health scale is based on general mental health perceptions. Further comparisons of methods of assessing mental health are needed.

We observed a high frequency of patients with IIM experiencing post-COVID-19 disease flares. A past history of Asthma and those with certain acute COVID-19 symptoms were at higher risk. REFERENCES:

16 - Ethical issues in global mental health

Current efforts in global mental health (GMH) aim to address the inequities in mental health between low-income and high-income countries, as well as vulnerable populations within wealthy nations (e.g., indigenous peoples, refugees, urban poor). The main strategies promoted by the World Health Organization (WHO) and other allies have been focused on developing, implementing, and evaluating evidence-based practices that can be scaled up through task-shifting and other methods to improve access to services or interventions and reduce the global treatment gap for mental disorders. Recent debates on global mental health have raised questions about the goals and consequences of current approaches. Some of these critiques emphasize the difficulties and potential dangers of applying Western categories, concepts, and interventions given the ways that culture shapes illness experience. The concern is that in the urgency to address disparities in global health, interventions that are not locally relevant and culturally consonant will be exported with negative effects including inappropriate diagnoses and interventions, increased stigma, and poor health outcomes. More fundamentally, exclusive attention to mental disorders identified by psychiatric nosologies may shift attention from social structural determinants of health that are among the root causes of global health disparities. This paper addresses these critiques and suggests how the GMH movement can respond through appropriate modes of community-based practice and ongoing research, while continuing to work for greater equity and social justice in access to effective, socially relevant, culturally safe and appropriate mental health care on a global scale.

Global Mental Health (GMH) is the field of study, research, and intervention, which aims at improving access to mental health worldwide. It is based on the global burden of disease research program and on the existence of a large “treatment gap” between the need and availability of mental health services, displaying individual and social costs of undiagnosed and untreated mental disorders, especially in low- and middle-income countries (LMIC). Few academic publications in Brazil dialogue directly with the field of GMH, although several issues drawn from its agenda have been the subject of mental health policies in the country. Brazil can be classified as a middle-income country with a well-structured national health system. This system is oriented toward primary health care, which integrates both community mental health services and the broader health care network. The debate between GMH advocates and critics has unearthed old controversies in psychiatry such as universality or cultural specificity of mental disorders, their expressions, and their relationship with social and economic factors. We intend to examine how these controversies reverberate in the Brazilian mental health scenario, taking as an illustration the debates around Attention Deficit Hyperactivity Disorder (ADHD) in the country. ADHD discussions oppose those who argue that the condition is underdiagnosed and undertreated, and those who claim that there is overdiagnosis and overtreatment and thus, medicalization of childhood. This article presents the current status of the Brazilian mental health literature on ADHD, with emphasis on tensions around diagnosis, prevalence and interventions. Our aim is to highlight how the differential in discourse shapes the debate on ADHD in Brazil and how this may contribute to the GMH agenda. This goal will be undertaken in three steps. First, we will briefly examine studies around GMH and ADHD. Secondly, we address Brazilian studies on this theme, considering the specificities regarding the constitution of the mental health field. Finally, we will examine the debate of treatment gap vs. medicalization in the country in order to underscore the potentials and limitations of each perspective.

Different ways of thinking about policy-making for public and global mental health are constantly emerging. Turning patients into consumers and mental health into commodity may open the door for dystopic future of mental health care. Research has indicated that practicing love, kindness, and compassion for ourselves and others builds our confidence and sense of coherence, helps us create meaningful, caring relationships, increases individual and community resilience and well-being, promotes human rights, physical and mental health. Public and global mental health promotion may be predicated on the theory of salutogenesis and three key inter-related terms: empathy, coherence and resilience. The WHO Mental Health Action Plan 2013-20120 is based on the vision of a world in which mental health is valued, promoted and protected, and has four objectives: to improve leadership and governance, health and social care, promotion and prevention, and information and research. Practicing public and global actions that promote and educate empathy, coherence and resilience may significantly help achieving equality for mental health in the 21st century and improving public and global mental health.

Caregivers are essential in supporting cancer patients, especially those undergoing hematopoietic cell transplantation (HCT). While traditional interventions have been beneficial for improving health-related quality of life (HRQOL), they typically require significant time and staff resources. To address this, we developed the Roadmap mHealth app, which incorporates resilience-building features based on positive psychology. The app integrates Fitbit® devices to monitor and visualize steps, sleep, and self-reported mood in the Roadmap app. A two-arm randomized controlled trial (RCT) was conducted to evaluate the impact of Roadmap's positive activities on caregiver HRQOL, measured by PROMIS® Global Health (physical and mental components), at day-120 post-transplant compared to assessment-only controls. From September 08, 2020 to July 31, 2023, 168 dyads enrolled in the Roadmap study (82 intervention, 87 control). At day-120 post-HCT, there were no significant differences in PROMIS® Global Mental Health (48.18 vs. 48.16) or Global Physical Health (50.19 vs. 49.52) T-scores between the intervention and control arms. However, among caregivers who used positive activities and chat forum features in the intervention arm, daily mood significantly improved over time (β=0.0082, P<0.001, 95% CI= [0.0060, 0.0010]). Improved daily mood scores were positively associated with better PROMIS® Global Mental Health at days 30 and 120 post-HCT (β=0.6076, P=0.03, 95% CI=[0.0494, 1.166]). The Fitbit® device and Roadmap app also received net favorable ratings in feasibility and acceptability, indicating that they were generally easy-to-understand, set up, and use, and superior Mobile App Rating Scale (MARS) scores compared to published mental health apps, with no significant differences between study arms. Compliance with the intervention or control app declined over time. While the primary outcome, PROMIS® Global Health, did not differ between arms, caregivers who engaged in positive activities and chat forum through the app experienced a significant improvement in mood compared to those who did not. Additionally, caregivers reported the study as feasible and acceptable over the 120-day study period. Future directions for the Roadmap app are discussed based on these findings. ClinicalTrials.gov: NCT04094844, Registered 09-16-2019.

Upward mobility (via educational attainment) is highly valued, but longitudinal associations with mental and physical health among Black youths are less understood. To examine associations of childhood family disadvantage and college graduation with adult mental and physical health in Black youths followed up into adulthood. This longitudinal, prospective cohort study of Black youths from the state of Georgia who were studied for 20 years (ages 11 to 31 years) was conducted between 2001 and 2022. Participants for this study were drawn from the Strong African American Healthy Adults Program. Data analysis was conducted from April 2023 to January 2024. Family economic disadvantage (measured during the adolescent years) and college graduation (indicating upward mobility). Primary outcomes included mental health, substance use, and physical health. Mental health included a composite of internalizing and disruptive problems (anxiety, depression, anger, aggressive behaviors, and emotional reactivity). Substance use included a composite of smoking, drinking, and drug use. Physical health included metabolic syndrome (MetS) and proinflammatory phenotypes (immune cells mounting exaggerated cytokine responses to bacterial challenge and being insensitive to inhibitory signals from glucocorticoids). Mental and physical health measures were taken at age 31 and during the adolescent years. Linear and logistic regression analyses, as well as mediated moderation analyses, were conducted. The study population consisted of 329 Black youths (212 women [64%]; 117 men [36%]; mean [SD] age at follow-up, 31 [1] years). Compared with those who did not graduate college, those who graduated from college had 0.14 SD fewer mental health problems (b = -1.377; 95% CI, -2.529 to -0.226; β = -0.137; P = .02) and 0.13 SD lower levels of substance use (b = -0.114; 95% CI, -0.210 to -0.018; β = -0.131; P = .02). Residualized change scores revealed that college graduates showed greater decreases from age 16 to 31 years in mental health problems (b = -1.267; 95% CI, -2.360 to -0.174; β = -0.133; P = .02) and substance use problems (b = -0.116; 95% CI, -0.211 to -0.021; β = -0.136; P = .02). For physical health, significant interactions between childhood family disadvantage and college completion emerged in association with MetS (OR, 1.495; 95% CI, 1.111-2.012; P = .008) and proinflammatory phenotype (b = 0.051; 95% CI, 0.003 to 0.099; β = 0.131; P = .04). Among youths growing up in disadvantaged households, college completion was associated with a 32.6% greater likelihood of MetS (OR, 3.947; 95% CI, 1.003-15.502; P = .049) and 0.59 SD more proinflammatory phenotype (mean difference, 0.249, 95% CI, 0.001 to 0.497; P = .049). Conversely, among those from economically advantaged backgrounds, college completion was correlated with lower MetS and less proinflammatory phenotype. Findings held after controlling for body mass index at age 19 years. In this longitudinal cohort study of Black youths, graduating from college was associated with an adult profile of better mental health but poorer physical health among those from economic disadvantage. These findings suggest that developing interventions that foster healthy outcomes across multiple life domains may be important for ensuring that striving for upward mobility is not accompanied by unintended cardiometabolic risk.

Task sharing: stopgap or end goal?

This article charts the historical development of the discipline of global mental health, whose goal is to improve access to mental health care and reduce inequalities in mental health outcomes between and within nations. The article begins with an overview of the contribution of four scientific foundations toward the discipline's core agenda: to scale up services for people with mental disorders and to promote their human rights. Next, the article highlights four recent, key events that are indicative of the actions shaping the discipline: the Mental Health Gap Action Programme to synthesize evidence on what treatments are effective for a range of mental disorders; the evidence on task shifting to nonspecialist health workers to deliver these treatments; the Movement for Global Mental Health's efforts to build a common platform for professionals and civil society to advocate for their shared goal; and the Grand Challenges in Global Mental Health, which has identified the research priorities that, within the next decade, can lead to substantial improvements in the lives of people living with mental disorders. The article ends by examining the major challenges for the field, and the opportunities for addressing them in the future. (harv rev psychiatry 2012;20:6–12.)

This article addresses four major challenges for efforts to create synergy between the global mental health movement and cultural psychiatry. First, although they appear to share domains of mutual interest, the worlds of global mental health and cultural psychiatry have distinct lineages. Expanding their horizons by learning from adjacent disciplines would be mutually beneficial. A second challenge concerns the conceptualization of a new classification system for mental health problems. Adopting a classification system that integrates new insights from socio-neurobiology and from a networks perspective could bring cultural psychiatry and global mental health closer and change the way each field addresses the mental health gap, which constitutes the third challenge. I summarize attempts to achieve comprehensive mental health coverage around the globe and question whether the strategies employed to achieve these goals have been successful, both in high- (HIC) and low- and middle-income countries (LMIC). In LMIC, the dominant strategy needs to be complemented by mobilization of other community resources including local practitioners. A fourth challenge is the lack of mathematical models to guide action and research and solve major preoccupations such as access to care or multi-level analyses in complex ecological or health systems.

Purpose Investigate pain, fatigue, depressive symptoms and sleep disturbance in young adults with cerebral palsy compared to references. Materials and methods Young adults with cerebral palsy (n = 97, aged 21–34 years) and age-matched references from the general population (n = 190) rated pain using a numeric rating scale and fatigue, depressive symptoms, sleep disturbance and global health using Patient-Reported Outcomes Measurement Information System® short forms. Scores were compared between cerebral palsy subgroups and the reference population. Correlation coefficients and linear regression analyses assessed interrelationships of health issues and associations with global health. Results Individuals with Gross Motor Function Classification System level I had less pain, fatigue and depressive symptoms, while individuals with levels II and III–V had more pain (53% and 56%, p < 0.001) and those with levels III–V more fatigue (39%, p = 0.035) than references (pain: 26%, fatigue: 14%). Pain and fatigue were more interrelated (correlation coefficients: 0.71 vs. 0.41) and stronger associated with global mental health in individuals with cerebral palsy. Conclusions Young adults with Gross Motor Function Classification System levels II–V report more pain and those with levels III–V report more fatigue than references. Pain and fatigue are highly interrelated and specifically relate to mental health in individuals with cerebral palsy. Implications for rehabilitation Except for those in the highest level of motor function, young adults with cerebral palsy report higher levels of pain and fatigue compared to the general population of the same age. Pain and fatigue are strongly interrelated and associated with mental health in young adults with cerebral palsy. The present study recommends to monitor pain and fatigue in young adults with cerebral palsy with low levels of gross motor function. We advise rehabilitation professionals to consider combined treatment for both pain and fatigue.

PROMIS effectively assesses patient health, but its use in evaluating the quality of life in acute coronary syndrome (ACS) patients on PCSK9 inhibitors (PCSK9i) remains unexplored. This study examined the impact of PCSK9i on quality of life in ACS patients, comparing PCSK9i plus statin versus statin-only therapy using PROMIS-10, and analyzed the association between PROMIS scores and major adverse cardiovascular events (MACE). The EMSIACS trial is a prospective, randomized, open-label, parallel-group, multicenter study registered at ClinicalTrials.gov (NCT04100434). This paper presents the exploratory outcomes of this trial. From September 2020 to March 2022, a total of 500 ACS patients were enrolled. Patients were randomly assigned in a 1:1 ratio to receive Evolocumab plus statin therapy or statin-only therapy. The quality of life was assessed using PROMIS 10 at baseline, week 12, and week 48. PROMIS 10 includes two summary scores: Global Physical Health (GPH, including physical health, physical function, fatigue and pain intensity) and Global Mental Health (GMH, including overall quality of life, mental health, satisfaction with social activities, and emotional problems). At week 48, MACE were evaluated in two groups. At week 12, Evolocumab significantly improved Global Physical Health (GPH) (P < 0.001) and Global Mental Health (GMH) scores (P < 0.001), particularly in pain intensity, mental health, and social activity satisfaction (P < 0.001). By week 48, both groups improved significantly from baseline, with no significant differences between them(GPH: P = 0.120; GMH: P = 0.105). Emotional problems worsened in patients with MACE (P = 0.015). Exploratory analysis suggested that PCSK9i significantly improved short-term quality of life in ACS patients outperforming statins especially in pain intensity, mental health, and social activity satisfaction. In the long term, PCSK9i sustained quality of life improvements. The occurrence of MACE in ACS patients may associate with emotional problems.Clinical trial registration number: NCT04100434.