Aims.: There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems’ Effect on the Quality of Mental Health Care in Europe) project.Methods.: A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (≥18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS.Results.: The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona – Italy and Girona – Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sør-Trøndelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care.Conclusions.: There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.

Improving health literacy (HL) is critical for addressing health inequalities. Low literacy rates are believed to be more prevalent in ethnic minorities, which may have an impact on people’s health. For measures to be implemented in this regard, HL must be evaluated to obtain specific indicators. Our aim, therefore, was to develop a version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16), which is recommended to be used with vulnerable populations, suited to Arabic/French-speaking migrants who reside in south-eastern Spain, and to explore its psychometric properties for assessing health literacy in this population. A cross-sectional survey was carried out in a convenient sample of 205 migrants. The structural validity was calculated by a confirmatory factorial analysis (CFA), which suggested appropriate adjustment indicators, and which indicated that the three-dimensional model is adequately adjusted to the data obtained in the study. The coefficient omega showed high internal consistency in the three HL dimensions (health care, disease prevention, and health promotion). Concurrent validity presented a significant correlation with the Newest Vital Sign test (r = 0.390; p < 0.001). The multigroup CFA showed that the heterogeneity of the sample used was not a problem for establishing the structural validity of the scale. The Arabic/French version showed good construct validity.

Mental health care is a critical area to better understand integrated care and to pilot the different components of the integrated care model. However, there is an urgent need for better tools to compare and understand the context of integrated mental health care in Europe. The REMAST tool (REFINEMENT MApping Services Tool) combines a series of standardised health service research instruments and geographical information systems (GIS) to develop local atlases of mental health care from the perspective of horizontal and vertical integrated care. It contains five main sections: (a) Population Data; (b) the Verona Socio-economic Status (SES) Index; (c) the Mental Health System Checklist; (d) the Mental Health Services Inventory using the DESDE-LTC instrument; and (e) Geographical Data. The REMAST tool facilitates context analysis in mental health by providing the comparative rates of mental health service provision according to the availability of main types of care; care placement capacity; workforce capacity; and geographical accessibility to services in the local areas in eight study areas in Austria, England, Finland, France, Italy, Norway, Romania and Spain. The outcomes of this project will facilitate cooperative work and knowledge transfer on mental health care to the different agencies involved in mental health planning and provision. This project would improve the information to users and society on the available resources for mental health care and system thinking at the local level by the different stakeholders. The techniques used in this project and the knowledge generated could eventually be transferred to the mapping of other fields of integrated care.

Online surveys are increasingly used to investigate health conditions, especially among young people. However, this methodology presents some limitations including item nonresponse concerning sensitive and knowledge-related questions. This study aimed to suggest latent class analysis as the methodology to statistically deal with item nonresponse data, while describing item nonresponse in an online health survey addressed to young people. We used data from an e-cohort study on 8,663 French university students and identified six homogenous groups of students with similar use of nonresponse options (‘I don’t know’, ‘I’m not sure’, or ‘I don’t want to answer’): one of High Respondents (64.2%), four of Partial Respondents (34.3%), and one of High Nonrespondents (1.5%). Item nonresponse largely depended on the survey’s contextual features (type of nonresponse options, question domains), and was significantly associated with (non)respondents’ individual characteristics (gender, age, field of study). We conclude that item nonresponse can be very informative and that latent class analysis is a useful method to identify its patterns in online health surveys.

Background: Mental health literacy is a determinant of mental health, which can facilitate early detection of psychological problems and endorse timely access to care. Instruments to measure mental health literacy exist, but not in French. Assessment of mental health literacy in young adults is essential to tailor appropriate educational interventions promoting psychological wellbeing and preventing mental health problems in this vulnerable population. The aim of this study was to validate the French version of the Mental Health Literacy Scale (MHLS-FR) in university students. Methods: A total of 482 students from the University of Bordeaux, France, completed the translated version of the scale. Collected data were used to validate the MHLS-FR through psychometric analyses: descriptive statistics, item distribution, test-retest reliability, exploratory structural equation model, confirmatory factor analysis, Cronbach’s alpha and McDonald’s omega coefficients, and hypothesis testing. Results: The final scale included 26 items covering 6 dimensions. Cronbach’s alpha and McDonald’s omega coefficients were 0.744 and 0.961, respectively. With test-retest, about 50% of items had intraclass correlation coefficients superior to 0.5. Conclusions: The MHLS-FR can be considered as a valid and reliable instrument for measuring mental health literacy in French students.

To identify the individual and occupational factors that are predictors for low back pain among the employees of a university hospital in southern Spain. A transverse study was conducted in which the population used was the hospital employees who volunteered to participate. The information was obtained by using a questionnaire, which included demographic and anthropometric variables, habits, characteristics of the work done, and of any pain experienced. The mental health condition of subjects was measured using the GHQ-28, using a score of ≥6 as the cut-off point. To study the variables associated with pain, crude odds ratios (ORs) were calculated (± 95% Cl) and adjusted according to a logistic regression model. One thousand one hundred and four subjects participated in the study but only 890 of these completed the questionnaire in full (rate of response, 35.7% of total employees). The population studied was notable for the high proportion of women, for subjects >41 years of age, and subjects who undertook little or no physical exercise. In addition, according to the GHQ-28 test, 29.9% of the total were ‘probable psychiatric cases’. The crude ORs were high in all the occupational categories in comparison with the doctors, with the exception of the maintenance, cleaning, and catering group. They were also higher among women, among subjects with poor mental health, and among women with one or more children. The adjusted ORs showed that having a GHQ-28 score of ≥6, and belonging to the auxiliary technician category, were independent risk factors for suffering low back pain. Being older than 41 years and in temporary employment were protective variables. The presence of probable mental illness is the variable most strongly associated with the presence of low back pain in the population studied. Its diagnostic confirmation and appropriate treatment could contribute to reducing the prevalence of vertebral pains in this occupational group.