Final Report Summary - MARATONE (Mental Health Training through Research Network in Europe)
The Seventh Framework, Marie Curie Initial Training Network project “Mental Health Training through Research Network in Europe” or MARATONE created a network of multidisciplinary and inter-sectorial training-through-research that developed career pathways for young scientists in mental health to enhance European research capacity to meet the challenge of a comprehensive and integrated mental health strategy for Europe. Based on the theoretical hypothesis of a ’horizontal epidemiology’ of mental disorders, MARATONE ESRs developed methodologies and frameworks for describing and measuring the individual and social impact of these disorders for feasible health promotion and prevention strategies for integrated and practical social and private sector responses to mental health, including at the highest level, human rights protections within national policies and programming.
The hypothesis of horizontal epidemiology posited that the actual, lived experience of psychosocial difficulties associated with a very diverse set of mental health disorders are not exclusively determined by the diagnosis of the particular disorder in a vertical, silo-like pattern but ‘horizontally’ in a manner that reflects commonalities in the lived experience of people with very diverse mental health problems.
The 14 Early Stage Researchers (ESRs) brought together in the MARATONE project conducted PhD research under these topics, prepared deliverables associated with the five work packages and underwent extensive mandatory network and local specialized training courses in mental health epidemiology across the life span, depression and deliberate self-harm, mental health and well-being in workplace settings, human rights and ethics in mental health, as well as professional transferable skills of research management, entrepreneurial skills and commercial exploitation and dissemination. The ESRs also benefited from extended secondments to partners and associate partners in the MARATONE consortium, including the European Alliance Against Depression, the “Federacio Catalna d’Associacions de Familiars de Malalts”, the World Health Organisation, the International Labour Organisation and the European Brain Council.
At the close of the MARATONE project, the results of the training and research experience that the 14 ESRs have accumulated are now reaching fruition.
In the area of mental health epidemiology, the underlying concept of ‘horizontal epidemiology’ was confirmed in part by a study of the utility of using the common notion of functioning to horizontally link common mental disorders, and thereby to predict health service usage, and similar studies about common psychosocial difficulties were conducted and results published in the areas of schizophrenia and depression. Broadening the search, several studies on the association between social relationships and a range of mental health conditions, both across Europe and for comparison, in China, India and Latin American, disclosed crucial epidemiological trends where, once again, the impact of mental health disorders on patient’s lived experience proved to be the most salient predictor of a range of health outcomes, including suicidal ideation and mortality risk. Finally, research was conducted on the possibility of translating successes in web accessibility for persons with physical health problems to those with mental health conditions.
In depression and deliberate self-harm, relying on developments in mental health epidemiology, studies tracked what is known about the effectiveness of interventions for depression on functional areas of daily life, looked at the effectiveness of standard diagnostic tools for depression in terms of their capacity to predict the actual impact of the condition on people’s lives, and looked at the impact of socio-economic status on the lived experience of depression. Important work was performed on the other component of this topic, with studies on the epidemiology of suicide among young people and adults in Ireland and gender differences in suicide intent.
Research on depression and other mental health conditions in the workplace looked at the effectiveness of interventions that target the stigma of mental illness, suggesting that current approaches may not be effective. Two other studies on workplace interventions aimed at preventing common mental disorders at work broadened the focus by, on the one hand, performing economic evaluation of these interventions and surveying the field of workplace interventions beyond standard co-worker educational programmes to more innovative approaches using brief mindfulness and positive psychology approaches. These studies amply demonstrate the need for more rigorous, randomized controlled trials in this area.
The last topic area of the MARATONE project was human rights and combating stigma and social exclusion and here there was considerable work done relying on methodologies and research techniques that are not as common to mental health researchers. The stigma associated with mental health disorders has often been highlighted as a significant barrier, not only to diagnosis and treatment, but also to the quality of life of persons with these conditions. A secondary data analysis of the impact of a correlated barrier, namely negative perceptions of ageing exposed the links to depression and anxiety. The impact of similar negative attitudes towards persons in minimally conscious states on experienced functioning and disability was the focus of another study. Finally, the domain of human rights and mental health was explored by in-depth analysis of recent legal changes that have been made in mental health law because of the United Nations Convention on the Rights of Persons with Disabilities and a qualitative study of the impact of the Convention on the procedures in place, in five European countries on a legal action with enormous consequences for a person with mental health problems, namely court decisions regarding involuntary placement and treatment.
The hypothesis of horizontal epidemiology posited that the actual, lived experience of psychosocial difficulties associated with a very diverse set of mental health disorders are not exclusively determined by the diagnosis of the particular disorder in a vertical, silo-like pattern but ‘horizontally’ in a manner that reflects commonalities in the lived experience of people with very diverse mental health problems.
The 14 Early Stage Researchers (ESRs) brought together in the MARATONE project conducted PhD research under these topics, prepared deliverables associated with the five work packages and underwent extensive mandatory network and local specialized training courses in mental health epidemiology across the life span, depression and deliberate self-harm, mental health and well-being in workplace settings, human rights and ethics in mental health, as well as professional transferable skills of research management, entrepreneurial skills and commercial exploitation and dissemination. The ESRs also benefited from extended secondments to partners and associate partners in the MARATONE consortium, including the European Alliance Against Depression, the “Federacio Catalna d’Associacions de Familiars de Malalts”, the World Health Organisation, the International Labour Organisation and the European Brain Council.
At the close of the MARATONE project, the results of the training and research experience that the 14 ESRs have accumulated are now reaching fruition.
In the area of mental health epidemiology, the underlying concept of ‘horizontal epidemiology’ was confirmed in part by a study of the utility of using the common notion of functioning to horizontally link common mental disorders, and thereby to predict health service usage, and similar studies about common psychosocial difficulties were conducted and results published in the areas of schizophrenia and depression. Broadening the search, several studies on the association between social relationships and a range of mental health conditions, both across Europe and for comparison, in China, India and Latin American, disclosed crucial epidemiological trends where, once again, the impact of mental health disorders on patient’s lived experience proved to be the most salient predictor of a range of health outcomes, including suicidal ideation and mortality risk. Finally, research was conducted on the possibility of translating successes in web accessibility for persons with physical health problems to those with mental health conditions.
In depression and deliberate self-harm, relying on developments in mental health epidemiology, studies tracked what is known about the effectiveness of interventions for depression on functional areas of daily life, looked at the effectiveness of standard diagnostic tools for depression in terms of their capacity to predict the actual impact of the condition on people’s lives, and looked at the impact of socio-economic status on the lived experience of depression. Important work was performed on the other component of this topic, with studies on the epidemiology of suicide among young people and adults in Ireland and gender differences in suicide intent.
Research on depression and other mental health conditions in the workplace looked at the effectiveness of interventions that target the stigma of mental illness, suggesting that current approaches may not be effective. Two other studies on workplace interventions aimed at preventing common mental disorders at work broadened the focus by, on the one hand, performing economic evaluation of these interventions and surveying the field of workplace interventions beyond standard co-worker educational programmes to more innovative approaches using brief mindfulness and positive psychology approaches. These studies amply demonstrate the need for more rigorous, randomized controlled trials in this area.
The last topic area of the MARATONE project was human rights and combating stigma and social exclusion and here there was considerable work done relying on methodologies and research techniques that are not as common to mental health researchers. The stigma associated with mental health disorders has often been highlighted as a significant barrier, not only to diagnosis and treatment, but also to the quality of life of persons with these conditions. A secondary data analysis of the impact of a correlated barrier, namely negative perceptions of ageing exposed the links to depression and anxiety. The impact of similar negative attitudes towards persons in minimally conscious states on experienced functioning and disability was the focus of another study. Finally, the domain of human rights and mental health was explored by in-depth analysis of recent legal changes that have been made in mental health law because of the United Nations Convention on the Rights of Persons with Disabilities and a qualitative study of the impact of the Convention on the procedures in place, in five European countries on a legal action with enormous consequences for a person with mental health problems, namely court decisions regarding involuntary placement and treatment.