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Teachers are often the first persons responsible for identifying children with attention deficit hyperactivity disorder (ADHD) and are increasingly being called on to help manage such children. We sought to assess teachers' knowledge of and attitudes toward ADHD in Trinidad & Tobago, a small island developing state in the Caribbean region. Based on previously published work, an instrument was adapted and pilot tested. Using convenience sampling, 440 questionnaires were distributed and 277 valid questionnaires were returned (response rate, 63%). Total knowledge scores were low, mean 12.6/26. Both postgraduate education and in-service training significantly improved knowledge scores as did having previously taught a child with ADHD. Attitudes toward children with ADHD were generally positive although most teachers felt children with ADHD should be taught by specialist teachers. Results suggest greater efforts must be made to provide teacher training specifically in the identification and management of children with ADHD.

Background: Extensive evidence indicates that rates of psychotic disorder are elevated in more urban compared with less urban areas, but this evidence largely originates from Northern Europe. It is unclear whether the same association holds globally. This study examined the association between urban residence and rates of psychotic disorder in catchment areas in India (Kancheepuram, Tamil Nadu), Nigeria (Ibadan, Oyo), and Northern Trinidad. Methods: Comprehensive case detection systems were developed based on extensive pilot work to identify individuals aged 18–64 with previously untreated psychotic disorders residing in each catchment area (May 2018–April/May/July 2020). Area of residence and basic demographic details were collected for eligible cases. We compared rates of psychotic disorder in the more v. less urban administrative areas within each catchment area, based on all cases detected, and repeated these analyses while restricting to recent onset cases (<2 years/<5 years). Results: We found evidence of higher overall rates of psychosis in more urban areas within the Trinidadian catchment area (IRR: 3.24, 95% CI 2.68–3.91), an inverse association in the Nigerian catchment area (IRR: 0.68, 95% CI 0.51–0.91) and no association in the Indian catchment area (IRR: 1.18, 95% CI 0.93–1.52). When restricting to recent onset cases, we found a modest positive association in the Indian catchment area. Conclusions: This study suggests that urbanicity is associated with higher rates of psychotic disorder in some but not all contexts outside of Northern Europe. Future studies should test candidate mechanisms that may underlie the associations observed, such as exposure to violence. [ABSTRACT FROM AUTHOR]

It has been consistently reported that the African-Caribbean population in the UK are more likely than their White counterparts to access psychiatric services via the police and under compulsion. The reasons for these differences are poorly understood. This paper comprises two main parts. The first provides a comprehensive review of research in this area, arguing the current lack of understanding stems from a number of methodological limitations that characterise the research to date. The issue of ethnic variations in pathways to psychiatric care has been studied almost exclusively within a medical epidemiological framework, and the potential insights offered by sociological and anthropological research in the fields of illness behaviour and health service use have been ignored. This has important implications as the failure of research to move beyond enumerating differences in sources of referral to psychiatric services and rates of compulsory admission means no recommendations for policy or service reform have been developed from the research. The second part of the paper sets out the foundations for future research, arguing that the pathway to care has to be studied as a social process subject to a wide range of influences, including the cultural context within which illness is experienced. It is further argued that Kleinman's (Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine and psychiatry, University of California Press, Los Angeles, 1980) Health Care System model offers a particularly valuable preliminary framework for organising and interpreting future research. It is only through gaining a more qualitative understanding of the processes at work in shaping different responses to mental illness and interactions with mental health services that the patterns observed in quantitative studies can be fully understood. This further reflects the need for a bridge between the social sciences and psychiatry if services are to be developed to respond to the increasing diversity of modern societies. Keywords: African-Caribbean; Help-seeking; Psychiatric services; Ethnicity research; United Kingdom

The author offers a perspective on the mental health impact of COVID-19 pandemic. Pandemic-related mental health stressors include fear of infection and death, social distancing and unemployment. Effects of the pandemic include increased substance use, alcohol drinking and intimate partner violence, developmental and behavioral problems and academic performance decline in children and adolescents and greater likelihood of comorbidities, risk of depression, anxiety and dementia among elderly.

Trinidad and Tobago incur the highest (per capita) crime-related costs in the entire Latin America and the Caribbean region, totaling an estimated 1.6 billion US dollars in 2014. While regional crime-related costs are generally higher than global averages, the issue is particularly pronounced in Trinidad and Tobago. Its prison occupancy was greater than 100% and the number of police officers per 100,000 members of the general population was above both regional and global averages in 2014. In this paper, we argue that there is a significant link between ADHD and criminality. This assertion is supported by empirical data from the research literature identifying specific areas of the criminal justice system that are disproportionately affected by the disorder and thus increase the economic cost ADHD levies upon the nation. [ABSTRACT FROM AUTHOR]

Suicide is a major worldwide public health problem and is a significant problem for Trinidad and Tobago where high rates are evident over the past two decades. This study sought to review suicide data for Trinidad and Tobago for the period 2000-2016 and identify demographic trends and the most common methods used for completed suicide. Of 1609 cases for the 17-year period, there was a 6:1 male to female ratio of suicide in Trinidad and Tobago. The mean age of suicide was 39.5 years, though the greatest prevalence was in the 20-29-year age group (23.8%). Indo-Trinidadians accounted for 65.9% of suicide deaths. The South, South Western, and Central regions accounted for 63.2% of suicide deaths. Poisoning was the most commonly used method of suicide, closely followed by hanging (47% and 41.8% respectively). Preventive efforts should therefore target these particularly vulnerable population groups and seek to detoxify easily available lethal chemicals and closely monitor those at risk for suicidal behaviour. [ABSTRACT FROM AUTHOR]