Stress and burnout are clearly problems for mental health workers. In this paper, we present data from research study on moderators of burnout in mental health staff.

The purpose of this study was to explore the phenomenon of resilience as experienced by Russian mental health clinicians working in a highly demanding, specialized and stressful environment (e.g., staff shortages, health service shortages, not being notified of changes before they occurred).

The study used a range of self report questionnaires. Measures included a demographic checklist, the Hardiness Survey (Maddi 1984), and the GCOS – The General Causality Orientation Scale (Deci & Ryan 1985). The participants for this study were drawn from Medico-rehabilitation Unit, Psychiatric hospital, – the disciplines of psychiatry, clinical psychology and nursing. In all, 10 ward based mental health professionals were surveyed.

This paper outlines the results of these measures. This in turn allows us to develop intervention strategy to ensure an effective provision, which depends on satisfied professionals, who have a sense of ownership over what they do and an ability to shape the direction of their endeavours.

The study's findings have the potential to inform organizations in mental health to promote resilience in clinicians, to deliver stress management interventions for staff with the potential to reduce the risk of burnout and hence staff attrition, staff retention and mental health.

The authors have not supplied their declaration of competing interest.

There is an increased risk to develop mental disorder during adolescence and early adulthood. Given this vulnerability, and in order to facilitate the transition from child and adolescent to adult mental health services, specific services for this age group have been developed in the last years, focusing on accessibility and early referral of young mental patients. Our Psychiatry Department (Coimbra Hospital and University Centre, Portugal) created a specific unit for young adults in order to provide better care, in accordance with the specificities of this subpopulation. The team consists of psychiatrists, psychiatry residents, nurses and a clinical psychologist. Referred patients are under 20 years old, presenting clinically relevant psychopathology or behavior disturbances.

We aimed to characterize help-seeking outpatients regarding socio-demographic variables and its relation to depressive and anxiety symptoms.

Socio-demographic characterization was undertaken with young adult psychiatric outpatients observed during eleven months (1st January to 30th November 2015). Multivariate analyses were performed to identify a relationship among socio-demographic and psychopathology variables (assessed with the Portuguese version of Brief Symptom Inventory–53 itens).

One hundred and sixty-two outpatients were observed: 97 females (59,9%) and 65 males (40,1%), ages between 17 and 31 years old (average: 19,9; median: 20). We found a positive correlation between depressive and anxiety symptoms and the education level. A negative correlation was found between depressive and anxiety symptoms and male gender and presence of mental illness in the family.

The authors have not supplied their declaration of competing interest.

Mental disorders are one of the leading reasons for disability-related retirement and payment of associated long-term benefits in many countries.

To explore the characteristics of psychiatric outpatients who apply for disability pensions and to investigate the factors associated with making an application.

A four-month cross-sectional evaluation of disability pension and retirement applications to the psychiatry outpatient clinic in a university hospital in Istanbul.

The majority of 144 patients were male (n = 102, 70.8%), based in Istanbul, married, living with their families and had no occupation at the time of inquiry. Excluding applications for individuals with a diagnosis of intellectual disability (n = 44), most applicants were primary school graduates (n = 31, 32.3%). For the whole group, the median age of application was 34. 60%, (n = 87) had an established psychiatric diagnosis before the application, with average duration since diagnosis of approximately 8 years. The most frequent diagnoses were intellectual disability, followed by schizophrenia and depression. More than half of the patients were treated only outpatiently, with no hospitalization (n = 55, 58%). Thirty-two of them (22.4%) had a comorbid psychiatric diagnosis and 58 (40.3%) had at least one comorbid medical diagnosis.

There are some similarities between our findings and findings from other countries, such as low educational level and frequent comorbid somatic diseases among patients applying for disability pension. In contrast with the literature and as an indicator of social inequality, most patients applied for disability pension were male. The results are reflecting the specificities of different health systems and cultural perceptions of disability.

The authors have not supplied their declaration of competing interest.

Over the last eight decades, general hospital psychiatric units (GHPUs) have become important mental health service set-ups in India. This period has seen a large number of radical changes in the Indian society. In this background, it is important to know if it had any effects on the patients attending the GHPUs.

A total of five hundred subjects, attending a GHPU were recruited prospectively for the study. The subjects were assessed using a semi-structured proforma. A comparison was made with similar studies conducted in GHPU settings over the last 5 decades.

Neurotic, stress related and somatoform disorders was the commonest diagnostic group (33%) followed by psychotic disorders (17%) and mood disorders (15%). The finding is broadly similar to the studies done at different times in the last 5 decades. However, there were lesser number of patients with mental retardation, organic brain syndrome and seizure disorder.

The study highlights the strengths of GHPU set-ups like inter-speciality referrals, fewer stigmas, patients travelling from far off places to seek treatment and involvement of family in the care of mentally ill.

The authors have not supplied their declaration of competing interest.

Occupational psychiatry is the field of psychiatry that focuses on work, its importance in the lives of individuals and work organizations. It gained visibility in the 2000 decade, after the creation of the Academy of Occupational and Organizational Psychiatry. Following that trend, occupational psychiatry outpatient started in 2008 at Hospital de Santa Maria.

To describe the structure and functioning of that project; to characterize the population that has been referred to this subspecialty, as well as the main motives for referral; and to highlight some paradigmatic cases that deserve special attention.

Call attention to the importance of occupational psychiatry at the individual and institutional level.

All the patients ever referred to the occupational psychiatry consultation were considered for the analysis. Clinical information was obtained through medical records and interviews with the patients. Bibliographic research was conducted through the PubMed in the Medline library.

In our hospital, the prototype patient referred to occupational psychiatry is a middle-aged woman working as a medical assistant. The most frequent motives for referral were related to difficulties in accomplishing job duties and definite psychiatric diagnosis corresponded more often to the common mental disorders (anxiety, depression and adjustment disorders). At the institutional level, the initiative was received with great enthusiasm.

As Freud stated “To Love and work are the cornerstone of our humanness”, in line with that we consider that occupational psychiatry should be taken as a priority in what concerns to mental health policies.

The authors have not supplied their declaration of competing interest.

Mental health problems were shown by different studies to be both: results of and risk factors for unemployment. However, unemployed people with mental health problems often have difficulties in finding and using mental health services and therefore do not benefit from therapies. Because unemployed individuals outside the healthcare system are a hard-to-reach group, barriers to but also facilities for mental health services are poorly understood.

The aim of the study is to identify barriers and facilitators of help seeking and service use, based on experiences of unemployed people with mental health strains.

We conducted 15 qualitative semi-structured interviews with unemployed individuals, facing self-reported mental health problems or mental illness. Topics included individual experiences with help-seeking and mental health service use, with a focus on barriers and facilitators. Interviews were audiotaped and transcribed verbatim. Transcripts were analyzed using qualitative content analysis and major themes were identified.

Patients fear adverse reactions of psychiatric medication. They report to be treated as “different” by their social environment and health professionals, which leads to a lack of self-esteem and inhibits them in their help seeking efforts. Social support and desire for change on the other hand can be strong motivational factors in searching for help.

Perception of GPs towards mental health issues of their patients, and especially unemployed patients, has to be raised. Stigmatization of mental illnesses and help seeking should be reduced in practical context.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

To analyze the experience of BOS in medical residents of Mexico City.

Qualitative design with a phenomenological approach. Semi-structured interviews were conducted. Participants were medical residents in training who agreed to participate. Data analysis was based meaning categorization and condensation, as well as some elements of discourse analysis.

We had interviews with residents of gynaecology, otorhinolaryngology, family medicine and psychiatry. We have found that there are some specific aspects that contribute to the development BOS:

– the hidden curriculum that has become evident through unnecessary punishments;

– various roles to be met simultaneously by residents;

– the basic needs like sleeping and eating right are not being met due to excessive workload.

– impact in general health.

It is necessary to make visible the complexity of the BOS and its impact on trainees to prevent deterioration in the quality of life and overall health status. It would be to achieve the satisfaction of basic needs as essential conditions for physical and mental well-being of all human beings, and more so for those whose task is to contribute to the health of others.

The authors have not supplied their declaration of competing interest.

Currently, Ghana has only twelfth psychiatrists in active service providing for the mental health needs of a population of nearly 25 million people. Ghana has therefore adopted a system of task-shifting to address the critical shortage of psychiatrists.

To examine the perception of psychiatrists and health policy directors about the government's policy to expand metal health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs).

A self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors.

Only one psychiatrist and 3 (10.3%) health policy directors reported they were not aware of task-shifting within Ghana's mental health delivery system. Ten (91.1%) psychiatrists and 23 (79.3%) health policy directors were aware of a policy of the Government of Ghana to improve on the human resource base within mental health through a system task-shifting. Overall, 5 (45.5%) of the psychiatrists and 9 (31%) health policy directors perceived there are some resistance to the implementation of a policy of task shifting including resistance from traditional and spiritual healers, some psychiatrists, some community psychiatric nurses and psychologists. The majority of psychiatrists and health policy directors were of the view that CMHWs should be allowed to assess, diagnose and treat most of the common mental disorders.

Psychiatrists and health policy directors in Ghana support Governments policy to expand on mental health care delivery through a system of task-shifting despite their knowledge of resistance from certain professionals.

The authors have not supplied their declaration of competing interest.

This paper examines the historical development of mental health services in the UAE including formation of federal laws associated with mental health and ministerial decrees. It also discusses cultural considerations in mental health practice in a society that is highly pluralistic and populated mainly by foreigners. The sharia aspects of mental health are also addressed.

The aims of the paper are to familiarize readers in above areas and encourage further work in the area of mental health in UAE.

The research is based on literature review.

All federal laws and ministerial decrees are listed and local cultural considerations and sharia laws discussed, as they are unique to his country and region.

Although mental health is traditionally neglected in this country it is developing very fast and it is essential to keep track of and encourage such growth for the benefit of consumers and mental health professionals.

The authors have not supplied their declaration of competing interest.

WHO defines Sexual Health as “a state of physical, emotional, mental and social well-being in relation to sexuality… and requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence”.

OCD-10 defines Transsexualism as “the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment. The transsexual identity has been present persistently for at least two years. The disorder is not a symptom of another mental disorder or a chromosomal abnormality”.

We developed an integrative model in 4 axes to approach Sexual Health concept and Transsexualism.

Holistic and integrative model of transsexualism gives a better understanding of this disorder and ameliorates global treatment. Moreover, this model should be applied to each sexual minority.

1. Etiology integrates psychological, biological and neuro-developmental aspects. 2. Clinical features for treatment imply large and multidisciplinary approach. 3. Scientific literature includes more than thousand papers on Transsexualism and numerous expertises as endocrinology, psychiatry, cardiology, sleep… 4. Social networks are developed in hospitals, associations… as well as between patients themselves.

Holistic and integrative approach of Sexual Minority as Transsexualism could reach Sexual Health concept defined by WHO.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Supporting personal recovery has become the main aim for mental health services in many countries nowadays. In particular, the relationship between individual service users and staff members can be the key issue in supporting recovery and this requires specific measures in order to identify and evaluate the orientation of services in this process of change. INSPIRE is a standardized questionnaire developed by King's College, London that represents a service user-rated measure of staff support for personal recovery in the UK.

Although there is a number of instruments aimed at monitoring recovery in the clinical and functional features, there is still lack of measures for personal recovery and recovery orientation of services in the Italian background.

The aim of this study is to evaluate the psychometric properties of the Italian version of INSPIRE as it is applied in the Italian mental health services.

Two rounds of data were collected from a sample of 79 inpatients and outpatients of rehabilitation centers and consultant service of the municipality of Ravenna. Analysis was undertaken using SPSS. The main issues investigated were internal consistency, test-retest reliability and exploratory factor analysis.

The results in the present studies indicate that the Italian version of the INSPIRE measure had a very good internal consistency and a satisfactory test-retest reliability.

While further studies testing the instrument in larger and more diverse clinical contexts are needed, INSPIRE can be considered a relevant and feasible instrument to use in supporting the development of a recovery-oriented system in Italy.

The authors have not supplied their declaration of competing interest.

It is easy to find texts, in scientific literature, studying the adaptation of immigrants from developing countries in western countries. However, in these globalization times that we are living, few are the studies performed on members from developed countries emigrating to the third world.

To evaluate the factors predisposing to the onset of anxiety or depression symptoms in Spanish immigrants living in South Africa.

This is an exploratory study with a sample of 51 Spanish residents in South Africa between 24 and 57 years (44% male, 56% female), 44% of which were living there for more than two years. An online survey was administered, collecting data related to reasons and conditions for their moving to the country and traumatic events living during the stay. For the screening of depression and anxiety symptoms Hopkins Symptom Scale (HSCL-25) was used. Finally, we carried about several analysis using Chi2 test. For statistical analysis SPSS was utilized.

Thirty percent of the sample showed positive scores on anxiety symptoms scale, and 24% scored positive for depression. Job related items as being unemployed (P < 0.001) was associated to symptoms of depression. Insecurity/violence (P < 0.021) and race discrimination (P < 0.009) were the main factors related to anxiety symptoms.

Factor related to employment, security and discrimination, has been significantly associated to the onset of anxiety and depression symptoms. Other factors related to the moving to the country or social relationships have shown no relations. More studies are needed to provide information about adaptation and factors related to mental health in Occidental immigrants in developing countries.

The authors have not supplied their declaration of competing interest.

The aim of this paper is to study the profile of Moroccan users to contextualize interventions and to identify if specific requirements are observed.

A descriptive statistical analysis of sociodemographic and clinical variables are performed to acknowledge the differences between Moroccan users (n = 6) compared to the group of Spanish users (n = 12).

The following was found in the Moroccan users: the average age was 7 years higher. The percentage of Toxic abuse was slightly higher (83% vs 75%), although in comparison to the Spanish users the Moroccan users had double the percentage of patients treated in the Addictions center.

There were no significant differences in the duration of untreated psychosis (DUP) and in the duration of untreated illness (DUI). According to the referral, the Moroccan users were better detected in Primary care (50%/8%).

Regarding the PANSS negative symptoms predominated in Moroccan (45/20 percentile) and general psychopathology (65/35 percentile).

In the Social Functioning Scale (SFS), there are only differences in Autonomy Execution (T score = 104/T = 92).

The Family Questionnaire (FQ) shows that families reported greater frequency and discomfort of symptoms and the user as less capable of controlling themselves. Finally, the Global Assessment of Functioning (GAF) offers an average of nearly 15 points lower.

The training area stands out as a handicap in the rehabilitation process. Clinically negative symptoms and general discomfort are factors that limit the overall functioning. More specific interventions are also required for the families of these users.

The authors have not supplied their declaration of competing interest.

The Early Psychosis Intervention Programme (EPIP) in South Granada serves a population with a first psychotic episode. In 2014, 16 patients entered the program, 6 of whom were North Africans.

It is justified by clinical and health care needs to adapt and contextualize care plans and interventions to the specific necessities of this population: considering its suffering meaning and interpretation.

A descriptive study of the data obtained in this population with the Scale of Positive and Negative Syndrome of Schizophrenia (PANSS) arises.

In the positive scale, the 6 subjects score in the low range (between 6–25th percentile).

On the negative 2 score in the low range and 4 in the middle (between 26–74th percentile).

In the compound scale in 3 cases, the predominance of negative symptoms is in the low range scale, the rest is in the middle range.

Finally, in general psychopathology scale, 2 subjects scored in the low range, the same who scored in the same range in the negative scale. Two subjects scored in the midrange and 2 in the high.

According to data, positive symptoms do not stand out among this group of patients. As for negative symptoms, if the range is low, so is the measure of general psychopathology. If the range is average, general psychopathology is medium-high. Also, when the range is average in negative symptoms, means the compound profile reflects predominance of negative syndrome. This reveals the importance of emphasizing a negative symptoms approach and its relationship with general psychopathology.

The authors have not supplied their declaration of competing interest.

The brain drain of mental health professionals is an important issue especially for developing countries with inadequate recruitment rates. The European Federation of Psychiatric Trainees (EFPT) investigated the extent of migration among trainees across Europe by Brain Drain research project. Results from a non-EU country, with the lowest number of mental health professionals per 100 000 population across OECD countries might provide important clues.

To identify attitudes towards and behaviors towards international migration among psychiatry trainees from Turkey.

An online survey was conducted among psychiatry trainees from Turkey in 2013, as part of the EFPT Brain Drain Research Project.

Of 107 trainees surveyed, 74% considered living abroad. However, the rate of having even short mobility experience was just 13%, and these were mainly educational visits. More than half of those who visited a foreign country reported to have a satisfactory experience, which might explain the positive influence of these visits on attitudes towards migration. Responders perceived academic conditions as the most important aspect of training that needs to be improved, in line with the fact that inadequate training programs were important reasons for migrating.

Overall, psychiatry trainees in Turkey tend to remain in their country of origin, which may protect healthcare system against the detriment of workforce loss. The relatively low rate of migration may also reflect the legislative barriers (e.g. being o non-EU country) impeding migrating. Our findings also suggest that the unmet educational needs of trainees require immediate attention.

The authors have not supplied their declaration of competing interest.

Recent studies point for an increased incidence of psychotic disorders among immigrants when compared to nom-immigrant population, with a substantial risk variation being observed among different ethnic minority groups and diverse host countries/societies.

This communication explores the relation between immigration and the onset of psychosis disease, namely the individual and socio-environmental factors implicated in this association.

Accessing the implications of immigration in the establishment of psychotic disorders.

The authors conducted a literary search on Medline and PsychInfo databases regarding the subject immigration and psychotic disorders, elaborating a bibliographic review of the topic.

A greater incidence of psychotic disorders in immigrants (in comparison to nom-immigrant population) has been established. In actuality a range of studies carried out in different socio demographic contexts and with different ethnic groups (of immigrants) identify ethnicity, neighbourhood characteristics (namely level ethnic density), discrimination and refugee status, as some of the probable factors that modulate the rate of psychotic disorder and influence its incidence in immigrants.

With regard to the relationship between immigration and the development of psychosis, much is still to be understood. Future studies with focuses on different individual, social, cultural and demographic aspects need to be developed in order to better understand and addressed this phenomenon.

The authors have not supplied their declaration of competing interest.

Emigration and remigration are one of the greatest modern problems and considered as a factor provoking manifestation and exacerbation of mental disorders as well as pathocharacterological personality changes. In emigrants and re-emigrants peculiarities of course of depressive disorders with different genesis are not investigated, that impedes a development of adequate therapeutic methods.

To study clinical-psychopathological peculiarities of depressive disorders in emigrants and re-emigrants patients with psychogenic (F43.21, F43.22) (69 non-emigrants, 68 emigrants, 67 re-emigrants), endogenous (F31.3, F31.4, F32.1, F32.2, F33.1, F33.2) (65, 66 and 63 patients, respectively) and organic depressive disorders (F06.3) (64, 62 and 61 patients, respectively) were examined.

A clinical-psychopathological investigation, Standardized Personality Examination Method, Lusher's Method of Color Choices, HDRS, HARS, MADRS, and SCL-90-R.

The highest level of severity of depressive disorders in re-emigrants and the lowest level in non-emigrants were registered. Re-emigrants had predominantly depressive, asthenic-depressive and apathic-depressive forms, whereas emigrants had mainly anxious-depressive ones. According to SCL-90-R data, emigrants had higher indexes of somatization, obsessive-compulsive disorders, anxiety, whereas re-emigrants had higher indexes of depression and interpersonal sensitivity as well as an index of distress expression. In patients examined it was determined a predomination of dysthymic personality traits manifested in the frameworks of the leading depressive of anxious-depressive syndromes. An influence of emigration and remigration factors was the greatest in psychogenic depressions and the lowest in organic depressive disorders.

The abovementioned regularities should be taken into account in pharmacotherapy and a social-psychological support for such patients.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.