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Rimsha answered on
Apr 20 2021
DEPRESSION: PRIMARY CARE SERVICES AVAILABLE FOR YOUNG HOMELESS PEOPLE LIVING WITH DEPRESSION
(CRITICAL LITERATURE REVIEW)
Table of Contents
Introduction 3
Context of the Topic 3
Background of the Topic 3
Search Strategy 4
Databases 4
Selection of Materials 4
Inclusion and Exclusion Criteria 4
Review of Key Articles or Papers and Other Sources 5
Theme 1: Ba
iers in Accessing Primary Care 5
Theme 2: Relation between Access to Primary Healthcare and Hospitalisation of Homeless People 8
Theme 3: Mo
idity amongst Homeless People 11
Bibliography 14
Appendices 17
Appendix 1: PRISMA Flow Chart 17
Appendix 2: Critical Appraisal Table 18
Appendix 2: Inclusion/ Exclusion Criteria for Articles 29
Introduction
Context of the Topic
For many years, mental health issues are considered taboo and people were very reluctant to discuss the issues in public. Although, cu
ent scenario is better than before, people now open to speak about their issues with doctors and often with close friends and families. There are many policies implemented by the government all over the world with the intention to improve the mental health of their world, yet these policies fail to address all the mental issues and reach all kinds of communities. The cu
ent study tries to study about the impact of the primary health care services for the young homeless people suffering from depression.
Background of the Topic
As mentioned by Saadi et al. (2019), depression is very common mental health issue, which exist in the world. It has been seen that people at least once in their life suffered from the depression. Depression can remain temporary and went like a phase of life or it remains for very long period. Depression is responsible for the death of many of the people and lowers the productivity of the society. It can also reduce quality of life of the individuals suffering from it. As stated by Thompson et al. (2019), there is high rate of depression among people. Most of the people suffered because they fail to get proper diagnosis for their condition.
This is dangerous as depression is responsible for the development of the suicidal traits in people suffering from it. Depression is directly linked to the health condition of the person. It has been seen that depression worsens the health condition of people suffering from chronic diseases. Although, depression have different impact on different people, but certain group of people have high vulnerability towards depression. These groups are older people, teenagers and homeless people. On the contrary, as stated by Stone (2019), homelessness is a situation where individuals fail to get the decent house to life and proper parameters to secure them. Their housing condition lacks the minimum standards of living.
Homeless people lack the proper place to seek refuge at night. Homelessness can be temporary, situational or permanent, depending on the situation. It has been seen that homeless people live under high distress, which results into depression. Since homeless people fail to get proper diagnosis for their condition and basic treatment for their disease, therefore, it becomes difficult for the primary healthcare services to reach the homeless people, as they do not have any permanent place to live. Apart from this, homeless people show high reluctance towards the treatment mental healthcare. Thus, it is necessary to understand the impact of primary healthcare services in improving the life of homeless people.
Search Strategy
Databases
The large number of databases had been searched to find the relevant literature article. The reputed databases are searched retrieved the research articles. These databases include Google Scholar, NCBI, PubMed and ProQuest.
Selection of Materials
The articles were searched from the past ten years, which is between 2011 and 2020. The Boolean operators such as AND, OR, NOT was used to reaches the specific articles. The articles searched were peer reviewed and full texts of them were available. Preference was given to random clinical trials articles. Apart from this, the key terms used for the search include homelessness, depression and primary healthcare services.
Inclusion and Exclusion Criteria
There are the certain criteria, which had been strictly followed while searching for the research articles. One of the primary choices for inclusion or exclusion of research article is based on the country. The research articles belonging to the United Kingdom are selected, which includes both studies conducted in the United Kingdom as well as published in the same country. Apart from this, only new papers were selected. These papers were not more than ten years old. Paper between 2011 and 2020 were selected, whereas papers of 2010 and earlier were rejected as large numbers of changes occur between past ten years. Thus, older data can alter the results because they are outdated results.
On the contrary, there are three key terms, which are mandatory for the selection of the paper. These terms include depression, homelessness and primary care. All papers, which lack any of the three key terms, were excluded as they left the purpose of study incomplete. On the contrary, all the papers, which have all three terms included are selected as these papers provide link between homelessness and depression, as well as impact of primary healthcare in dealing with both the issues together.
The last and very important criteria for the inclusion and exclusion of the paper are availability of the research article. Most of the peer-reviewed articles, which are available in full text, are selected so that complete data can be extracted for the literature review. Articles, which are not peer-reviewed or do not have free access to the full text, are rejected.
Review of Key Articles or Papers and Other Sources
Theme 1: Ba
iers in Accessing Primary Care
The article by Bristow et al. (2011) aims to understand the experience of seeking care for distress from the perspective of potential patients from “hard-to-reach” groups, which states that most of the people living in United Kingdom when suffered from mental health issues managed to get the primary healthcare services. On the contrary, many of the individual fail to access the care due to unavailability of the service or their interaction with the care providers deter. This article focusses on the hypothesis and work to prove it. It conducted the qualitative study within the AMP programme to evaluate the factors critically, which prevent homeless people or other in distress to access primary care.
Most of the people especially when they belong to the vulnerable group such homeless people either divert from help seeking or lose the connection with the care provider due to lack of staying at one place. The interview had been conducted on the people who suffer from the eating disorder and are homeless. People belonging to the community Chinese Irish, Somali and South Asian are selected. All these people are linked to the AMP programme. The interview of the people is conducted to get the results. All the participants were given their permission and voluntarily participated in the study. Around 34 people were selected. The result is developed after conduction of the thematic analysis. The finding states that there are four factors, which directly related to the access to the primary care. These factors are conceptualising distress, ba
iers to help seeking, seeking help and navigating and negotiation services. The conceptualising distress includes issues faced by the patient in their life such as trauma like being raped or chronic disease.
On the contrary, people try to get help for their mental condition from various sources but they fail to consider general practitioners as their first or prefe
ed choice for treatment. They fail consider general practitioners as the appropriate treatment for their condition. Apart from this, most of the time, these people visited to the general practitioners for the treatment of their physical condition, they never discuss their mental conditions with the doctor such as variation in their mood. In addition to this, it has been seen that people in utter crisis due to their mental condition forced people to seek treatment, which they are usually reluctant to take.
Apart from this, community support given to the people living in distress can help them in accessing primary healthcare treatment. There are many issues, which act as ba
iers in accessing primary healthcare services. It has been seen that many of the homeless people have bad experience with their service providers as poor services were given to them. Lack of communication is because lack of knowledge of English makes it difficult to seek proper treatment. Navigation is necessary for availing the constant services from the primary care. It has been seen that difficulty in registering with the general practitioners, which results in dete
ing the relationship between patient and general practitioner. This research helps in finding the factors, which increases the issue of depression and identify the role, which needs to be played by healthcare professionals in helping these people.
Similarly, the article by Lamb et al. (2012) also supports this fact, stating that depression could not be analysed through on perceptions. It must be understood through social and medical point of view. This is because factors, which affect the depression, include medical condition as well as the social situation. It has been seen that knowledge of the depression is accessed and providing the help related to the depression had been influenced from the vast range of disciplines such as clinical and applied social science. There are wide range of interventions, which can be adopted to improve the outcomes of depression and anxiety. It has been seen that many of the people fail to seek help and reluctant to interact with the care providers.
On the contrary, many of the care providers fail to address the mental need of the people. This article conducted the systematic search for the qualitative articles and focus on experience of the eight groups with the issues such as homelessness, long-term unemployment, and depression in elderly, adolescents with eating disorders, advanced cancer sufferers, asylum seekers, patients with medically unexplained symptoms and people from black and minority ethnic groups. Twenty articles representing these groups are selected and its findings were synthesised to develop the results.
The finding suggests the large range of mechanisms for poor access among these groups. Many of the people consider their mental health issues are rooted in their social problems. There are a large number of strategies such as self-management strategies, which had been adopted to maintain the function. These kinds of strategies include social withdrawal and focussing on the available resources on close family relationships and work roles. It has been seen that when people conduct the over investment in their roles, it could result into sense of insecurity because large networks were neglected.
On the other hand, it has been seen that when there is occu
ence of the material disadvantage, it causes impact on both the influence on the help seeking as well as resource that can help the people in performing their social roles. Apparently, understanding of the psychological, material and social costs of engagement by healthcare professionals and patients could have impact on the decision to seek and offer help. The cost of engagements can be felt to be present higher in the deprived, marginalised and minority communities in comparison to the general communities. This is because individuals belonging to these communities have limited resources and the stigma related to the mental health illness is too high. This result can be applied to the local population as it provides the generalised result.
Besides, the paper by Upshur et al. (2018) also states and critically evaluates the homeless women situation. It states that homeless people are at high risk for substance use disorder and their proportion of homeless population is growing constantly. Earlier studies suggest that one-third of the street and shelter population is dependent on the alcohol use. Majority of them have been suffered from alcohol use problems and other illegal drug use. Primary care clinics registered the data that most of the homeless women visited the clinic with substance abuse problem.
Although, homeless women do not prefer to live in the street locations such as abandoned buildings and parks where risk of substance use disorder is high, yet the unstable living condition...