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Stone LMD, Millman ZB, Öngür D, Shinn AK. The Intersection Between Childhood Trauma, the COVID-19 Pandemic, and Trauma-related and Psychotic Symptoms in People With Psychotic Disorders. SCHIZOPHRENIA BULLETIN OPEN 2021; 2:sgab050. [PMID: 34881362 PMCID: PMC8643711 DOI: 10.1093/schizbullopen/sgab050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction People with psychotic disorders may be disproportionately affected by the traumatic effects of the COVID-19 pandemic. Childhood trauma, which also increases vulnerability to subsequent stressors, is common in individuals with psychosis. In this study, we investigated the intersection of the pandemic, childhood trauma, and psychotic and trauma-related symptoms in individuals with psychotic disorders. Methods We administered a cross-sectional survey to 151 participants [47 schizophrenia (SZ), 53 psychotic bipolar disorder (BP)], 51 healthy control (HC)] during the COVID-19 pandemic. Participants were asked about exposure to the pandemic’s impacts, childhood trauma, and post-traumatic stress, dissociative, and psychotic symptoms. Results BP reported greater negative impacts to emotional health than SZ and HC and to non-COVID physical health than HC. SZ reported less impact on work and employment during the pandemic. There were no other group differences in pandemic-related adversities. We also found that cumulative exposure to the pandemic’s negative impacts was significantly associated with PTSD symptoms but not psychotic or dissociative symptoms. Moreover, the number of adversities an individual experienced during the pandemic was strongly associated with the cumulative number of traumatic experiences they had in childhood. Discussion Our results suggest that having a psychotic disorder does not, in and of itself, increase susceptibility to the pandemic’s negative impacts. Instead, we provide evidence of a graded relationship between cumulative exposure to the pandemic’s negative impacts and PTSD symptom severity, as well as a graded relationship between cumulative childhood traumatic experiences and the number pandemic adversities, across diagnoses.
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Affiliation(s)
- Lena M D Stone
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA
| | - Zachary B Millman
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dost Öngür
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ann K Shinn
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Yen CF, Liao HY, Lee Y, Hsu ST. Loneliness in patients with schizophrenia. TAIWANESE JOURNAL OF PSYCHIATRY 2021. [DOI: 10.4103/tpsy.tpsy_14_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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53
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Badcock JC, Adery LH, Park S. Loneliness in psychosis: A practical review and critique for clinicians. ACTA ACUST UNITED AC 2020. [DOI: 10.1111/cpsp.12345] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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54
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Bowman S, McKinstry C, Howie L, McGorry P. Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review. Early Interv Psychiatry 2020; 14:655-676. [PMID: 32026624 DOI: 10.1111/eip.12928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
AIM Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment. METHOD This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school. RESULTS In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature. CONCLUSION Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, School of Allied Health, LaTrobe University, Melbourne, Australia
| | - Carol McKinstry
- Department of Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Melbourne, Australia
| | - Linsey Howie
- Department of Occupational Therapy, School of Clinical and Community Allied Health, LaTrobe University, Melbourne, Australia
| | - Patrick McGorry
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, Melbourne, Australia
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Predicting psychosis-spectrum diagnoses in adulthood from social behaviors and neighborhood contexts in childhood. Dev Psychopathol 2020; 32:465-479. [PMID: 31014409 DOI: 10.1017/s095457941900021x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research showing that risk for schizophrenia, bipolar disorder with psychosis, and other psychosis-spectrum diagnoses in adulthood is multidetermined has underscored the necessity of studying the additive and interactive factors in childhood that precede and predict future disorders. In this study, risk for the development of psychosis-spectrum disorders was examined in a 2-generation, 30-year prospective longitudinal study of 3,905 urban families against a sociocultural backdrop of changing economic and social conditions. Peer nominations of aggression, withdrawal, and likeability and national census information on neighborhood-level socioeconomic disadvantage in childhood, as well as changes in neighborhood socioeconomic conditions over the lifespan, were examined as predictors of diagnoses of schizophrenia, bipolar disorder, and other psychosis-spectrum disorders in adulthood relative to developing only nonpsychotic disorders or no psychiatric disorders. Individuals who were both highly aggressive and highly withdrawn were at greater risk for other psychosis-spectrum diagnoses when they experienced greater neighborhood disadvantage in childhood or worsening neighborhood conditions over maturation. Males who were highly aggressive but low on withdrawal were at greater risk for schizophrenia diagnoses. Childhood neighborhood disadvantage predicted both schizophrenia and bipolar diagnoses, regardless of childhood social behavior. Results provided strong support for multiple-domain models of psychopathology, and suggest that universal preventive interventions and social policies aimed at improving neighborhood conditions may be particularly important for decreasing the prevalence of psychosis-spectrum diagnoses in the future.
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56
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Gleeson JFM, Lim MH. Commentary on loneliness and its association with health service utilization in people with a psychotic disorder. Schizophr Res 2020; 223:73-74. [PMID: 32646805 DOI: 10.1016/j.schres.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 11/25/2022]
Affiliation(s)
- J F M Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Australia.
| | - M H Lim
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Australia; Centre for Mental Health, Swinburne University of Technology, Australia
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Badcock JC, Di Prinzio P, Waterreus A, Neil AL, Morgan VA. Loneliness and its association with health service utilization in people with a psychotic disorder. Schizophr Res 2020; 223:105-111. [PMID: 32518000 DOI: 10.1016/j.schres.2020.05.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Loneliness is common in people with psychotic disorders and associated with reduced health and well-being. The relationship between loneliness in psychosis and health service use is unclear. This study examined whether loneliness predicts increased health care utilization in this population, independently of sociodemographics, health and functioning. METHODS We used cross-sectional data from the Second Australian National Survey of Psychosis. Loneliness was assessed using a single-item question, rated on a 4-point scale (not lonely; lonely occasionally; some friends but lonely for company; socially isolated and lonely). Health service use (past 12-months) was measured by the number of general practitioner (GP), emergency department (ED) and outpatient visits, inpatient admissions, and home visits by mental health professionals. Frequent hospital users comprised those in the top 15% of users of at least two services. RESULTS Negative binomial regression analysis showed that loneliness was associated with an increased number of GP visits, ED visits and inpatient admissions, only. Socially isolated and lonely survey participants were more than twice as likely (OR = 2.6) of being 'frequent users' compared to non-lonely responders. Following stringent adjustment for covariates, loneliness remained significantly associated with being a 'frequent user' and showed a non-significant trend to an increased number of GP visits and inpatient admissions. CONCLUSIONS Loneliness is a complex social and personal problem for people with psychosis, related to greater use of some health services. Better strategies for identifying and responding to loneliness in this population have the potential to increase well-being and contain health service utilization costs.
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Affiliation(s)
- Johanna C Badcock
- School of Psychological Science, University of Western Australia, Perth 6009, Australia; Perth Voices Clinic, Murdoch 6150, Australia.
| | - Patsy Di Prinzio
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Australia
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Australia; Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Australia
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Australia; Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Australia
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Quadt L, Esposito G, Critchley HD, Garfinkel SN. Brain-body interactions underlying the association of loneliness with mental and physical health. Neurosci Biobehav Rev 2020; 116:283-300. [DOI: 10.1016/j.neubiorev.2020.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
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Mucheru D, Ashby S, Hanlon MC, McEvoy M, MacDonald-Wicks L. Factors to consider during the implementation of nutrition and physical activity trials for people with psychotic illness into an Australian community setting. BMC Health Serv Res 2020; 20:743. [PMID: 32787846 PMCID: PMC7425062 DOI: 10.1186/s12913-020-05629-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 08/05/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Research in lifestyle interventions focusing on nutrition and physical activity in people living with psychotic illness, highlights anthropometric and metabolic benefits of these interventions. However, little is known about potential factors to consider during implementation into real-world contexts. Community-managed organisations (CMOs) that provide services for people with mental illness, offer an ideal implementation context for lifestyle interventions. Successful translation of lifestyle interventions into CMOs may be achieved though considering the factors associated with program access and delivery in these settings. This study primarily aimed to identify the factors that affect program access in a local CMO from the perspective of consumers and staff. The secondary aim was to describe the elements that impact on program delivery from the perspective of staff. METHODS Thirteen semi-structured interviews were conducted with 6 consumers and 7 staff in a CMO in regional Australia. Topics explored in interviews were based on implementation concepts identified in the "Integrated Promoting Action on Research Implementation in Health Systems" (i-PARIHS) knowledge translation framework. Thematic data analysis was conducted using Nvivo software. RESULTS Emergent themes on issues that influenced program access were (1) consumer financial status, domestic responsibilities, and health; (2) the design and delivery of programs; (3) structure and practices of the organisation; (4) attitude, skills and effort of staff involved in program delivery; and (5) social connections and stigma experienced by consumers during program access. Moreover, staff perceptions on elements that impacted program delivery highlighted themes on consumer attendance and interest in prospective programs, availability and restrictions to the use of funding, as well as the organisational structure and practices. CONCLUSIONS The factors affecting program access and delivery can generally be managed or planned for during the design of lifestyle interventions and subsequent translation into the CMO context. However, resolution of issues related to consumer financial status and health requires the collaboration of various government sectors for system-wide solutions.
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Affiliation(s)
- Doreen Mucheru
- Faculty Health and Medicine, The University of Newcastle, Callaghan, 2308 Australia
| | - Samantha Ashby
- Faculty Health and Medicine, The University of Newcastle, Callaghan, 2308 Australia
| | - Mary-Claire Hanlon
- Faculty Health and Medicine, The University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, 2308 Australia
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton, 2305 Australia
- Hunter Cancer Research Alliance, The University of Newcastle, Callaghan, 2308 Australia
| | - Mark McEvoy
- Faculty Health and Medicine, The University of Newcastle, Callaghan, 2308 Australia
- Centre for Clinical Epidemiology & Biostatistics, Hunter Medical Research Institute, New Lambton, 2305 Australia
| | - Lesley MacDonald-Wicks
- Faculty Health and Medicine, The University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, 2308 Australia
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Nhunzvi C, Langhaug L, Mavindidze E, Harding R, Galvaan R. Occupational justice and social inclusion among people living with HIV and people with mental illness: a scoping review. BMJ Open 2020; 10:e036916. [PMID: 32784258 PMCID: PMC7418773 DOI: 10.1136/bmjopen-2020-036916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore ways in which occupational justice and social inclusion are conceptualised, defined and operationalised in highly stigmatised and chronic conditions of mental illness and HIV. DESIGN This scoping review protocol followed Arksey and O'Malley's (2005) Scoping Review Framework. DATA SOURCES AND ELIGIBILITY The following databases were searched for the period January 1997 to January 2019: Medline via PubMed, Scopus, Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX and grey literature.Eligible articles were primary studies, reviews or theoretical papers which conceptualised, defined and/or operationalised social inclusion or occupational justice in mental illness or HIV. STUDY APPRAISAL AND SYNTHESIS We undertook a three-part article screening process. Screening and data extraction were undertaken independently by two researchers. Arksey's framework and thematic analysis informed the collation and synthesis of included papers. RESULTS From 3352 records, we reviewed 139 full articles and retained 27 for this scoping review. Definitions of social inclusion and occupational justice in the domains of mental illness and HIV were heterogeneous and lacked definitional clarity. The two concepts were conceptualised as either processes or personal experiences, with key features of community participation, respect for human rights and establishment and maintenance of healthy relationships. Conceptual commonalities between social inclusion and occupational justice were premised on social justice. CONCLUSIONS To address lack of clarity, we propose further and concurrent exploration of these concepts, specifically with reference to persons with comorbid mental health disorders such as substance use disorders and HIV living in low-income countries. This should reflect contextual realities influencing community participation, respect for human rights and meaningful occupational participation. From this broadened understanding, quantitative measures should be applied to improve the standardisation of measurements for occupational justice and social inclusion in policy, research and practice.
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Affiliation(s)
- Clement Nhunzvi
- College of Health Sciences, Rehabilitation Department, University of Zimbabwe, Harare, Zimbabwe
| | - Lisa Langhaug
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, African Mental Health Research Initiative (AMARI), Harare, Zimbabwe
| | - Edwin Mavindidze
- Occupational Therapy, Ingutsheni Central Hospital, Bulawayo, Zimbabwe
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Roshan Galvaan
- Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
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A pilot digital intervention targeting loneliness in young people with psychosis. Soc Psychiatry Psychiatr Epidemiol 2020; 55:877-889. [PMID: 30874828 DOI: 10.1007/s00127-019-01681-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/25/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Loneliness has been identified as a significant challenge for people with psychosis. Interventions targeting loneliness are lacking but adopting a positive psychology approach may reduce loneliness, promote well-being, and support meaningful social interactions. Together with youth mental health consumers, we developed a digital smartphone application (app) called +Connect, which delivers positive psychology content daily for 6 weeks. MATERIALS AND METHODS Twelve participants diagnosed with a psychotic disorder were recruited from early psychosis services. Loneliness was assessed pre-intervention, post-intervention, and 3-month post-intervention. Acceptability, feasibility, and usability were measured post-intervention, including a semi-structured interview on the user's experience of +Connect. RESULTS We found evidence for the feasibility of +Connect. All but two participants completed the +Connect program, completing 95% (40.10 out of 42 days) of the program. Furthermore, 66.67% (8 out of the 12 participants) remained engaged with the program 3-months post-intervention. Our data indicates preliminary evidence that +Connect may reduce loneliness, with scores from pre-intervention (M = 50.00, SD = 8.47) to post-intervention (M = 48.10, SD = 10.38) and 3-months post-intervention (M = 42.89, SD = 7.04). We found that positive reinforcement of in-game rewards and evidence of positive mood changes added to the feasibility of the app. Regarding acceptability, while 10% (1/10 participants) reported not finding +Connect useful or enjoyable, 90% of participants agreed that +Connect helped them to increase their social confidence, enjoy life, look forward to being with other people, and feel more connected with others. Participant interviews supported these results, with participants highlighting the app's strengths in providing useful information, stimulating self-reflection, fostering positive affect, and encouraging transfer of skills into their social interactions. DISCUSSION While preliminary findings indicated that +Connect yielded high levels of acceptability and feasibility, it is important to consider that we recruited a small and selected sample of lonely young people. Further iterations of this proof of concept app, which can incorporate participant feedback such preferences for increased personalisation, in-app feedback, and gamification, may allow an opportunity to test an improved version in the future.
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Chan SY, Brady R, Hwang M, Higgins A, Nielsen K, Öngür D, Hall MH. Heterogeneity of Outcomes and Network Connectivity in Early-Stage Psychosis: A Longitudinal Study. Schizophr Bull 2020; 47:138-148. [PMID: 32572485 PMCID: PMC7825010 DOI: 10.1093/schbul/sbaa079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Imaging studies in psychotic disorders typically examine cross-sectional relationships between magnetic resonance imaging (MRI) signals and diagnosis or symptoms. We sought to examine changes in network connectivity identified using resting-state functional MRI (fMRI) corresponding to divergent functional recovery trajectories and relapse in early-stage psychosis (ESP). Prior studies have linked schizophrenia to hyperconnectivity in the default mode network (DMN). Given the correlations between the DMN and behavioral impairments in psychosis, we hypothesized that dynamic changes in DMN connectivity reflect the heterogeneity of outcomes in ESP. Longitudinal data were collected from 66 ESP patients and 20 healthy controls. Longitudinal cluster analysis identified subgroups of patients with similar trajectories in terms of symptom severity and functional outcomes. DMN connectivity was measured in a subset of patients (n = 36) longitudinally over 2 scans separated by a mean of 12 months. We then compared connectivity between patients and controls, and among the different outcome trajectory subgroups. Among ESP participants, 4 subgroups were empirically identified corresponding to: "Poor," "Middle," "Catch-up," and "Good" trajectory outcomes in the complete dataset (n = 36), and an independent replication (n = 30). DMN connectivity changes differed significantly between functional subgroups (F3,32 = 6.06, P-FDR corrected = .01); DMN connectivity increased over time in the "Poor" outcome cluster (β = +0.145) but decreased over time in the "Catch-up" cluster (β = -0.212). DMN connectivity is dynamic and correlates with a change in functional status over time in ESP. This approach identifies a brain-based marker that reflects important neurobiological processes required to sustain functional recovery.
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Affiliation(s)
- Shi Yu Chan
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,To whom correspondence should be addressed; Psychosis Neurobiology Lab/Schizophrenia and Bipolar Disorders Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478; tel: 1-617-855-3528, fax: 1-617-855-2895, e-mail:
| | - Roscoe Brady
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA
| | - Melissa Hwang
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA
| | - Amy Higgins
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA
| | - Kathryn Nielsen
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA
| | - Dost Öngür
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Mei-Hua Hall
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
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Roberts T, Gureje O, Thara R, Hutchinson G, Cohen A, Weiss HA, John S, Lee Pow J, Donald C, Olley B, Miguel Esponda G, Murray RM, Morgan C. INTREPID II: protocol for a multistudy programme of research on untreated psychosis in India, Nigeria and Trinidad. BMJ Open 2020; 10:e039004. [PMID: 32565481 PMCID: PMC7311008 DOI: 10.1136/bmjopen-2020-039004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION There are few robust and directly comparable studies of the epidemiology of psychotic disorders in the Global South. INTREPID II is designed to investigate variations in untreated psychotic disorders in the Global South in (1) incidence and presentation (2) 2-year course and outcome, (3) help-seeking and impact, and (4) physical health. METHODS INTREPID II is a programme of research incorporating incidence, case-control and cohort studies of psychoses in contiguous urban and rural areas in India, Nigeria and Trinidad. In each country, the target samples are 240 untreated cases with a psychotic disorder, 240 age-matched, sex-matched and neighbourhood-matched controls, and 240 relatives or caregivers. Participants will be followed, in the first instance, for 2 years. In each setting, we have developed and are employing comprehensive case-finding methods to ensure cohorts are representative of the target populations. Using methods developed during pilot work, extensive data are being collected at baseline and 2-year follow-up across several domains: clinical, social, help-seeking and impact, and biological. ETHICS AND DISSEMINATION Informed consent is sought, and participants are free to withdraw from the study at any time. Participants are referred to mental health services if not already in contact with these and emergency treatment arranged where necessary. All data collected are confidential, except when a participant presents a serious risk to either themselves or others. This programme has been approved by ethical review boards at all participating centres. Findings will be disseminated through international conferences, publications in international journals, and through local events for key stakeholders.
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Affiliation(s)
- Tessa Roberts
- Health Service & Population Research department, Institute of Psychiatry Psychology and Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience and Substance Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Oyo, Nigeria
| | | | - Gerard Hutchinson
- Department of Psychiatry, The University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Tunapuna-Piarco, Trinidad and Tobago
| | - Alex Cohen
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Helen Anne Weiss
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, India
| | - Joni Lee Pow
- Department of Psychiatry, The University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Tunapuna-Piarco, Trinidad and Tobago
| | - Casswina Donald
- Department of Psychiatry, The University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Tunapuna-Piarco, Trinidad and Tobago
| | - Bola Olley
- Department of Psychiatry, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | - Georgina Miguel Esponda
- Health Service & Population Research department, Institute of Psychiatry Psychology and Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Craig Morgan
- Health Service & Population Research department, Institute of Psychiatry Psychology and Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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Winterton A, Rødevand L, Westlye LT, Steen NE, Andreassen OA, Quintana DS. Associations of loneliness and social isolation with cardiovascular and metabolic health: a systematic review and meta-analysis protocol. Syst Rev 2020; 9:102. [PMID: 32366295 PMCID: PMC7199368 DOI: 10.1186/s13643-020-01369-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 04/27/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A growing number of studies suggest that social isolation and loneliness are associated with premature mortality and are more prevalent among people with mental illness than in the general population, outlining many potential paths to disease still to be elucidated. The purpose of this meta-analysis is to examine the relationship between loneliness, social isolation, and established cardiovascular/metabolic risk factors and disorders, especially in severe mental illness, and to account for potential heterogeneity in the literature. METHODS/DESIGN Studies that report measures of loneliness and/or social isolation along with cardiovascular/metabolic risk factors will be identified. PubMed, EMBASE (through Ovid SP), Scopus, and PsycINFO (through Ovid SP) will be searched, along with citation lists of retrieved articles and the Cochrane Database of Systematic Reviews. Grey literature will be searched using Google Scholar. Data will be extracted from eligible studies for a random effects meta-analysis. For each study, a summary effect size, heterogeneity, risk of bias, publication bias, and the effect of categorical and continuous moderator variables will be determined. DISCUSSION This proposed systematic review and meta-analysis will identify and synthesise evidence to determine if there is an association between loneliness, social isolation, and cardiovascular/metabolic risk factors, with a special focus on severe mental illnesses. The results will help determine links and promising avenues of further research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018111911.
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Affiliation(s)
- Adriano Winterton
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956, N-0424, Oslo, Nydalen, Norway
| | - Linn Rødevand
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956, N-0424, Oslo, Nydalen, Norway
| | - Lars T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956, N-0424, Oslo, Nydalen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956, N-0424, Oslo, Nydalen, Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956, N-0424, Oslo, Nydalen, Norway
| | - Daniel S Quintana
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956, N-0424, Oslo, Nydalen, Norway.
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Correlates of loneliness among persons with psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2020; 55:549-559. [PMID: 31667560 DOI: 10.1007/s00127-019-01789-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Persons diagnosed with schizophrenia spectrum disorders (SSDs) often experience pervasive feelings of loneliness, which are considered a significant barrier to treatment and recovery. AIM As impaired social cognition may contribute to increased loneliness and less skillful social interactions, this study examines the relationships between loneliness and measures of social cognition and functional outcome from the Social Cognition Psychometric Evaluation (SCOPE) study. METHODS This study evaluated the relationship between loneliness, social cognitive ability, and social functioning in the context of a large-scale psychometric investigation. We also explored the associations of select demographic characteristics and clinical variables on the endorsement of loneliness in persons diagnosed with a psychotic disorder. RESULTS Seventy-four stable outpatients with SSDs and 58 healthy controls completed the UCLA Loneliness Scale in addition to the standard SCOPE battery. Our findings support prior research indicating persons diagnosed with a psychotic disorder experience greater levels of loneliness than normative groups. However, the results also indicate that self-reported loneliness is not associated with social cognitive abilities or functional outcome in psychosis. Regression analyses indicate that roughly half the variance in loneliness endorsed by persons with SSDs is accounted for by clinical variables, with loneliness most strongly associated with guilt and self-esteem. CONCLUSION These findings suggest that treatments aiming to reduce perceived social isolation in psychosis should incorporate techniques to bolster selfesteem, reduce guilt, and improve depressive symptoms.
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Narita Z, Stickley A, DeVylder J. Loneliness and psychotic experiences in a general population sample. Schizophr Res 2020; 218:146-150. [PMID: 32014362 DOI: 10.1016/j.schres.2020.01.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/28/2019] [Accepted: 01/19/2020] [Indexed: 12/12/2022]
Abstract
Increased loneliness has been associated with common mental disorders including psychotic disorders. However, as yet, little information is available on the association between loneliness and the occurrence of psychotic experiences (PEs), especially when adjusted for confounding factors. To address this deficit, the current study examined the relationship between PEs and loneliness in a general population sample in the United States (N = 974). We fitted three regression models to examine the associations between loneliness and PEs, using hierarchical adjustments for sociodemographic factors, adverse childhood experiences, and common mental disorders. Even at the highest level of adjustment, loneliness was significantly associated with increased odds for any PEs (OR = 1.25, 95% CI = 1.13-1.39). The same applied to the association between loneliness and delusional mood (OR = 1.29, 95% CI = 1.15-1.44). For delusion of reference and persecution, delusions of control, and hallucinations, there were no significant associations when adjusted for sociodemographic factors, adverse childhood experiences, and common mental disorders. These results suggest that increased loneliness is associated with PEs, particularly delusional mood. Future studies should employ longitudinal data and biological measures to examine potential causal relationships and underlying mechanisms.
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Affiliation(s)
- Zui Narita
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States.
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo 1878553, Japan
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, 113 W 60th St, New York, NY 10023, United States; Institute of Comparative Culture, Sophia University, 7-1 Kioicho, Chiyoda-ku, Tokyo 102-8554, Japan.
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Hanssen E, Balvert S, Oorschot M, Borkelmans K, van Os J, Delespaul P, Fett AK. An ecological momentary intervention incorporating personalised feedback to improve symptoms and social functioning in schizophrenia spectrum disorders. Psychiatry Res 2020; 284:112695. [PMID: 31831201 DOI: 10.1016/j.psychres.2019.112695] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/10/2019] [Accepted: 11/16/2019] [Indexed: 12/22/2022]
Abstract
This study examined the feasibility and effectiveness of an interactive smartphone application that aimed to improve daily-life social functioning and symptoms in schizophrenia spectrum disorders (SZ) with Experience Sampling Method (ESM) derived personalised feedback.Two groups of outpatients with a diagnosis of SZ were included (one receiving ESM-derived personalised feedback (n = 27) and one without feedback (n = 23)) and used the interactive smartphone application for three weeks. Main outcomes were momentary symptoms and social functioning, as assessed by ESM questionnaires. Additionally, feasibility and user-friendliness of the application were assessed. The response rate was 64% for the ESM questionnaires. In the feedback group, participants indicated that on 49% of the ESM days they acted on at least one personalised feedback prompt per day. Momentary psychotic symptoms significantly decreased over time only in the feedback group. Momentary loneliness and questionnaire-assessed psychotic symptoms decreased over time, irrespective of feedback. Participants evaluated the app as user-friendly and understandable. Momentary personalised feedback may impact momentary psychosis in daily life. Feelings of loneliness and questionnaire-based measured psychotic symptoms may be more responsive to non-specific effects of daily-life self-monitoring, not requiring specific feedback. Ecological momentary interventions offer opportunities for accessible and effective interventions in SZ.
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Affiliation(s)
- Esther Hanssen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, and Institute for Brain and Behaviour Amsterdam, Vrije Universiteit Amsterdam, the Netherlands.
| | - Sanne Balvert
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, and Institute for Brain and Behaviour Amsterdam, Vrije Universiteit Amsterdam, the Netherlands
| | | | - Karel Borkelmans
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands; Mondriaan Mental Health Trust, Heerlen, The Netherlands
| | - Anne-Kathrin Fett
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, and Institute for Brain and Behaviour Amsterdam, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychology, City University of London, London, United Kingdom; CSI Lab, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
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McGuire N, Melville C, Karadzhov D, Gumley A. “She is more about my illness than me”: a qualitative study exploring social support in individuals with experiences of psychosis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2020. [DOI: 10.1080/17522439.2019.1699943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nicola McGuire
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Andrew Gumley
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Chau AKC, Zhu C, So SHW. Loneliness and the psychosis continuum: a meta-analysis on positive psychotic experiences and a meta-analysis on negative psychotic experiences. Int Rev Psychiatry 2019; 31:471-490. [PMID: 31331209 DOI: 10.1080/09540261.2019.1636005] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
There is an increase in interest in the relationships between loneliness and psychosis. The notion of psychosis continuum implies that psychotic experiences extend from clinical populations with psychotic disorders to non-clinical populations. This meta-analytic review aimed to examine the respective associations of loneliness with positive and negative psychotic experiences along the psychosis continuum. A systematic database search was conducted and a total of 30 studies were included in the first meta-analysis and 15 studies were included in the second meta-analysis. There was a medium association between loneliness and positive psychotic experiences (r = 0.302, p < 0.001). In particular, the association between loneliness and paranoia was robust (r = 0.448, p < 0.001). The second meta-analysis revealed a medium association between loneliness and negative psychotic experiences (r = 0.347, p < 0.001). The associations between loneliness and both positive and negative psychotic experiences were found to be smaller among clinical than non-clinical samples. The above findings provided evidence for the associations between loneliness and the two core dimensions of psychotic experiences along the phenomenological continuum. Future research should examine the dynamics of these relationships in both clinical and non-clinical samples, preferably using a single-symptom approach.
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Affiliation(s)
- Anson K C Chau
- Department of Psychology, The Chinese University of Hong Kong , Hong Kong SAR , PR China
| | - Chen Zhu
- Department of Psychology, The Chinese University of Hong Kong , Hong Kong SAR , PR China
| | - Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong , Hong Kong SAR , PR China
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Poon AWC, Hayes L, Harvey C. Care-giving by people with psychotic disorders in the second Australian prevalence study of psychosis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1042-1052. [PMID: 30723953 DOI: 10.1111/hsc.12721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/12/2018] [Accepted: 12/29/2018] [Indexed: 06/09/2023]
Abstract
Increasing numbers of people living with psychosis are providing care for others, although the associated benefits and impacts are poorly understood. This innovative quantitative study investigated this life role using a population-based framework aiming to compare the mental health and functioning of those providing care to and/or receiving care from others. Care-giving provided by people with psychosis was examined using data from the second Australian prevalence survey of psychosis. This epidemiologically based sample (n = 1,822) was divided into four subgroups based on providing and/or receiving care from others. Independent functioning, cognitive functioning, social functioning, social connection and mental health were compared between the four subgroups. One in seven participants were providing care to others. The majority of carers were female and half were living with the care recipients. Caregivers were more likely to experience better illness course and were more commonly diagnosed with bipolar disorder. Almost one-third of caregivers reported that caring adversely affected their lives a great deal. Functioning and social connection were better in caregivers compared to non-caregivers, although cognitive functioning did not differ. People with psychosis who were neither providing nor receiving care were more likely to be single and perceive less warmth in their relationships. As expected, those only in receipt of care were living with greater disability and poorer illness course. It is relatively common to encounter people with psychosis who provide care to others in clinical settings, and women in particular combine care-giving with multiple other roles. Despite most experiencing some negative emotional impact, care-giving is associated with enhanced social relationships which may provide meaning and purpose for recovery. Care-giving roles should be addressed in recovery and care planning so as to provide people with psychosis with adequate information and support to fulfil these potentially important life roles.
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Affiliation(s)
| | - Laura Hayes
- Parenting Research Centre, East Melbourne, Vic., Australia
| | - Carol Harvey
- Department of Psychiatry, University of Melbourne and North Western Mental Health, Melbourne, Vic., Australia
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Bjornestad J, Hegelstad WTV, Berg H, Davidson L, Joa I, Johannessen JO, Melle I, Stain HJ, Pallesen S. Social Media and Social Functioning in Psychosis: A Systematic Review. J Med Internet Res 2019; 21:e13957. [PMID: 31254338 PMCID: PMC6625220 DOI: 10.2196/13957] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/06/2019] [Accepted: 05/10/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Individuals with psychosis are heavy consumers of social media. It is unknown to what degree measures of social functioning include measures of online social activity. OBJECTIVE To examine the inclusion of social media activity in measures of social functioning in psychosis and ultrahigh risk (UHR) for psychosis. METHODS Two independent authors conducted a search using the following electronic databases: Epistemonikos, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, Embase, and PsycINFO. The included articles were required to meet all of the following criteria: (1) an empirical study published in the English language in a peer-reviewed journal; (2) the study included a measure of objective or subjective offline (ie, non-Web-mediated contact) and/or online social functioning (ie, Web-mediated contact); (3) the social functioning measure had to be used in samples meeting criteria (ie, Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases) for a psychotic disorder or UHR for psychosis; and (4) the study was published between January 2004 and February 2019. Facebook was launched as the first large-scale social media platform in 2004 and, therefore, it is highly improbable that studies conducted prior to 2004 would have included measures of social media activity. RESULTS The electronic search resulted in 11,844 distinct articles. Full-text evaluation was conducted on 719 articles, of which 597 articles met inclusion criteria. A total of 58 social functioning measures were identified. With some exceptions, reports on reliability and validity were scarce, and only one measure integrated social media social activity. CONCLUSIONS The ecological validity of social functioning measures is challenged by the lack of assessment of social media activity, as it fails to reflect an important aspect of the current social reality of persons with psychosis. Measures should be revised to include social media activity and thus avoid the clinical consequences of inadequate assessment of social functioning. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42017058514; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017058514.
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Affiliation(s)
- Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | | | - Henrik Berg
- Norsk Lærer Akademi, University College, Bergen, Norway
| | - Larry Davidson
- School of Medicine, Yale University, New Haven, CT, United States
- Institution for Social and Policy Studies, Yale University, New Haven, CT, United States
| | - Inge Joa
- Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helen J Stain
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
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Pinto da Costa M, Chevalier A, Farreny A, Cassidy M, Leverton M, Toner S, Priebe S. How would patients with psychosis like to be in contact with a volunteer: Face-to-face or digitally? PLoS One 2019; 14:e0216929. [PMID: 31095611 PMCID: PMC6522036 DOI: 10.1371/journal.pone.0216929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 05/01/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Volunteer befriending can be used to address social isolation in patients with psychosis. Traditionally this involves face-to-face encounters between a volunteer and a patient, but modern digital technology also makes it possible to have these interactions remotely. This study aimed to explore the views and interests of patients with psychosis about different formats of volunteering, face-to-face or digitally. Methods A survey was conducted with patients with psychotic disorders in community mental health teams in London. Questions covered socio-demographic characteristics, quality of life, loneliness, views on the different formats of volunteering and types of volunteers, and their interest in getting volunteering support, face-to-face or digitally. Binary logistic regressions were used to investigate potential predictors of interest in getting volunteering support face-to-face or digitally. Results A total of 151 patients with psychotic disorders were included in this study. More than half of the patients (n = 87, 57.6%) had not heard about these volunteering programs. Many were interested in getting face-to-face (n = 87, 57.6%) and digital (n = 56, 37.1%) volunteering. For the face-to-face encounters, most preferred them to be weekly (n = 36, 41.4%), for one-hour (n = 32, 36.8%), and with an open-ended relationship (n = 45, 51.7%). For the digital contacts, most preferred them to be weekly (n = 17, 30.9%) and through text messages (n = 26, 46.4%). A minority of patients (n = 20, 13.2%) did not use digital technology. Patients with lower quality of life were significantly more likely to prefer face-to-face volunteering (p < .05). Younger patients and with fewer years of diagnosis were significantly more likely to prefer digital volunteering (p < .05). Conclusions The variability in patients’ interests suggests that different formats of volunteer support should be offered. Digital volunteering may become more important in the future, since many younger patients are interested in it.
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Affiliation(s)
- Mariana Pinto da Costa
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom
- Hospital de Magalhães Lemos, Porto, Portugal
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- * E-mail:
| | - Agnes Chevalier
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom
| | - Aida Farreny
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom
| | - Megan Cassidy
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom
| | - Monica Leverton
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom
| | - Sarah Toner
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom
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Pennou A, Lecomte T, Potvin S, Khazaal Y. Mobile Intervention for Individuals With Psychosis, Dual Disorders, and Their Common Comorbidities: A Literature Review. Front Psychiatry 2019; 10:302. [PMID: 31130884 PMCID: PMC6510170 DOI: 10.3389/fpsyt.2019.00302] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/17/2019] [Indexed: 12/24/2022] Open
Abstract
Over 50% of people diagnosed with a severe mental illness, such as schizophrenia or bipolar disorder, will meet criteria for a substance use disorder in their lifetime. This dual disorder often starts during youth and leads to significant societal costs, including lower employability rates, more hospitalizations, and higher risk of homelessness and of suicide attempts when compared to those with a serious mental illness without substance misuse. Moreover, many individuals presenting with comorbid disorders also present with other psychological difficulties as well, such as personality disorders or anxiety and depression, also known as complex comorbid disorders. Transdiagnostic treatments that focus on core difficulties found in people with complex dual disorders, such as emotional regulation, are direly needed. Emotional regulation skills can help reduce distress related to psychotic symptoms and maintain abstinence in substance use disorders. New technologies in the field of communications have developed considerably over the past decade and have the potential to improve access to such treatments, a major problem in many health care settings. As such, this paper aims at: presenting core difficulties present in many individuals with dual disorders, reviewing the scientific literature pertaining to the use of mobile applications in mental health and addictions, and presenting the development and potential of a new application for emotional regulation for people with dual disorders.
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Affiliation(s)
- Antoine Pennou
- Schizophrenia and Psychoses Study Laboratory for Intervention and Recovery, Department of Psychology, University of Montreal, Montreal, QC, Canada
- Research Center of the Montreal Mental Health University Institute, Intervention Axis and Services & Neurobiology and Cognition, Mental Health University Institute of Montreal, Montreal, QC, Canada
| | - Tania Lecomte
- Schizophrenia and Psychoses Study Laboratory for Intervention and Recovery, Department of Psychology, University of Montreal, Montreal, QC, Canada
- Research Center of the Montreal Mental Health University Institute, Intervention Axis and Services & Neurobiology and Cognition, Mental Health University Institute of Montreal, Montreal, QC, Canada
| | - Stéphane Potvin
- Research Center of the Montreal Mental Health University Institute, Intervention Axis and Services & Neurobiology and Cognition, Mental Health University Institute of Montreal, Montreal, QC, Canada
| | - Yasser Khazaal
- Research Center of the Montreal Mental Health University Institute, Intervention Axis and Services & Neurobiology and Cognition, Mental Health University Institute of Montreal, Montreal, QC, Canada
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Watson J, Fossey E, Harvey C. A home but how to connect with others? A qualitative meta-synthesis of experiences of people with mental illness living in supported housing. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:546-564. [PMID: 30027684 DOI: 10.1111/hsc.12615] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/18/2018] [Accepted: 06/16/2018] [Indexed: 05/18/2023]
Abstract
Supported housing principles emphasise the importance of decent, stable and affordable housing, and the provision of individualised support to enable people experiencing mental illness to live in their preferred communities, and to recover. This study sought to synthesise qualitative research addressing the question: how does living in supported housing facilitate social connections and participation from the viewpoints of people living with mental illness? Three databases (CINAHL, PsycINFO, Medline) were systematically searched to identify 19 peer-reviewed reports on 17 studies published during 2001-2016, in which the views and experiences of supported housing residents with mental illness were reported. Most studies were informed by grounded theory and used interview methods. Appraisal indicated the reports were of varying quality, but all met the inclusion criterion of reporting qualitative data relevant to the research question. Constant comparative methods were used to synthesise the reported data, and to identify themes across the studies. There were four overarching themes regarding the lived experience of supported housing for people with mental illness: (a) living in supported housing gave individuals privacy, a sense of control, stability and security; (b) stable housing supported residents' confidence to rebuild an identity and meaning in life, (c) there is a delicate balance between appreciating privacy and dealing with loneliness, and (d) opportunities and support to reconnect with families, friends and community are valued. The meta-synthesis findings highlight that supported housing residents face challenges of protecting their privacy and being lonely when on their own. Individualised support approaches need to attend to personal preferences for social participation and their varied meanings and significance. Further research is required to better understand how individualised forms of support can enable supported housing residents to connect with family, friends and community in their preferred ways.
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Affiliation(s)
| | - Ellie Fossey
- School of Primary and Allied Health Care, Monash University - Peninsula Campus, Frankston, Vic., Australia
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, University of Melbourne, & NorthWestern Mental Health, Coburg, Vic., Australia
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75
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Slotema CW, Bayrak H, Linszen MMJ, Deen M, Sommer IEC. Hallucinations in patients with borderline personality disorder: characteristics, severity, and relationship with schizotypy and loneliness. Acta Psychiatr Scand 2019; 139:434-442. [PMID: 30712290 DOI: 10.1111/acps.13012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE In patients with borderline personality disorder (BPD), data are lacking on characteristics and severity of hallucinations in modalities other than the auditory (verbal) type. The same applies to relationships between hallucinations and the severity of depression, anxiety, schizotypy, and loneliness. METHODS In 60 female patients with BPD (37 also with hallucinations), this cross-sectional study explored characteristics and severity of (i) hallucinations and (ii) schizotypal features, (iii) severity of depression and anxiety, and (iv) loneliness, and the relationships between hallucinations and the other characteristics. RESULTS In patients with hallucinations, 80% experienced hallucinations in more than one modality; in the different modalities, the characteristics of the hallucinations were similar. The criteria for loneliness were fulfilled in 81% and 48% of patients with and without hallucinations. Compared to patients with BPD without hallucinations, the presence of hallucinations was associated with higher scores for depression, anxiety, loneliness, and schizotypy. Furthermore, the severity of hallucinations showed a positive correlation with the severity of loneliness and schizotypy. CONCLUSION Patients with BPD experienced hallucinations with characteristics similar to the more frequently studied auditory (verbal) hallucinations. Higher scores for schizotypy and loneliness indicate that patients with hallucinations had more characteristics of cluster A personality disorders.
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Affiliation(s)
- C W Slotema
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - H Bayrak
- Health Center Medicaya, The Hague, The Netherlands
| | - M M J Linszen
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Deen
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - I E C Sommer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neuroscience, University Medical Center Groningen, Groningen, The Netherlands
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76
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Gardner A, Filia K, Killackey E, Cotton S. The social inclusion of young people with serious mental illness: A narrative review of the literature and suggested future directions. Aust N Z J Psychiatry 2019; 53:15-26. [PMID: 30309242 DOI: 10.1177/0004867418804065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Social inclusion involves objective participatory (e.g. education/employment) and subjective (e.g. sense of belonging/acceptance) elements across multiple domains. It has been associated with enhanced physical and mental wellbeing yet is a novel construct in the empirical literature (i.e. measures have not been sufficiently developed). AIMS Young people with serious mental illness are reported to be socially excluded. It is unclear whether this is reflected in the social inclusion/exclusion literature. The aim of this narrative review is to determine whether such literature permits a comprehensive (i.e. multi-dimensional, objective and subjective) understanding of social inclusion among young people with serious mental illness. METHODS Searches to identify studies related to the social inclusion and/or exclusion of young people with serious mental illness were conducted on 16 February 2016, 24 August 2016, 16 February 2017, 24 August 2017 and 16 February 2018 in PsycINFO, MEDLINE, the Cochrane Library, SCOPUS, Open Grey, Web of Science, Google and Google Scholar. RESULTS There is a paucity of research in the explicit social inclusion literature involving young people either with or without serious mental illness as participants. Literatures exist in related independent areas of research (e.g. employment, social networks), but such studies employ heterogeneous methodologies. CONCLUSION Multi-dimensional measures of social inclusion incorporating objective and subjective indicators must be developed for young people with and without serious mental illness. This will enable the generation of normative and clinical data. Existing evidence for the social exclusion of young people with serious mental illness comes from objective indicators in isolated domains (e.g. unemployment). Subjective indicators continue to be under-researched. The above-described measures must be employed to further understanding of the apparent discrepancies between young people with serious mental illness and those without serious mental illness. This will elucidate the relationships between objective and subjective elements of social inclusion and the relationships between these elements and the psychological distress that young people with serious mental illness often experience. This has implications for intervention.
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Affiliation(s)
- Andrew Gardner
- 1 Department of Research and Translation at Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,2 School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Kate Filia
- 1 Department of Research and Translation at Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,3 Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Eóin Killackey
- 1 Department of Research and Translation at Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,3 Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Sue Cotton
- 1 Department of Research and Translation at Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,3 Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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Neil AL, Carr VJ, Mackinnon A, Foley DL, Morgan VA. Health-Related Quality of Life in People Living with Psychotic Illness and Factors Associated with Its Variation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1002-1009. [PMID: 30098664 DOI: 10.1016/j.jval.2018.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/08/2018] [Accepted: 02/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To establish whether the four-dimensional Assessment of Quality of Life (AQoL-4D) produces robust utility values in adults with psychotic illness, and identify health inequalities compared with the general population. METHODS The AQoL-4D was completed by 1613 individuals with an International Classification of Diseases, Tenth Revision, psychotic illness in the 2010 Australian National Survey of Psychosis. Utilities were assessed for this sample and 20 subgroups, and were compared with general population norms. Modified Cohen d was used as an index of effect size. Utilities were collapsed into 10 health-related quality-of-life (HRQOL) bands or decades. RESULTS HRQOL in people with psychotic illness was half of the maximum achievable utility (half-"full health") with a mean utility of 0.49 (95% confidence interval [CI] 0.48-0.51), and showing substantial variability across subgroups. Participants with essentially normal functioning had the highest mean utility (0.72; 95% CI 0.68-0.77), and those with very poor perceived mental health had the lowest (0.22; 95% CI 0.18-0.26). These subgroups showed the most variability. Negative symptoms also gave rise to substantial variation. Among diagnostic categories, only depressive psychosis had a large effect relative to delusional disorders. The distribution of utilities in people with psychotic illness differed markedly from that in the general population, with 6.8% versus 47.2% having values in the highest decade (>0.90-1.00). Utilities were lower in every age group in people with psychosis. CONCLUSIONS Profound HRQOL impacts are revealed by the AQoL-4D in people with psychotic illness, and marked variations in utilities were observed for key subjective and objective measures. We provide a suite of utility values for economic modeling studies and recommend the AQoL-4D for assessing HRQOL in people with psychotic illness.
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Affiliation(s)
- Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Vaughan J Carr
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, St Vincent's Hospital, Sydney, New South Wales, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia; Department of Psychiatry, School of Clinical Sciences, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Andrew Mackinnon
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia; Black Dog Institute and University of New South Wales, Randwick, New South Wales, Australia
| | - Debra L Foley
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, Division of Psychiatry, Medical School, The University of Western Australia, Crawley, Western Australia, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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78
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Campbell LE, Hanlon MC, Galletly CA, Harvey C, Stain H, Cohen M, van Ravenzwaaij D, Brown S. Severity of illness and adaptive functioning predict quality of care of children among parents with psychosis: A confirmatory factor analysis. Aust N Z J Psychiatry 2018; 52:435-445. [PMID: 29103308 DOI: 10.1177/0004867417731526] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Parenthood is central to the personal and social identity of many people. For individuals with psychotic disorders, parenthood is often associated with formidable challenges. We aimed to identify predictors of adequate parenting among parents with psychotic disorders. METHODS Data pertaining to 234 parents with psychotic disorders living with dependent children were extracted from a population-based prevalence study, the 2010 second Australian national survey of psychosis, and analysed using confirmatory factor analysis. Parenting outcome was defined as quality of care of children, based on participant report and interviewer enquiry/exploration, and included level of participation, interest and competence in childcare during the last 12 months. RESULTS Five hypothesis-driven latent variables were constructed and labelled psychosocial support, illness severity, substance abuse/dependence, adaptive functioning and parenting role. Importantly, 75% of participants were not identified to have any dysfunction in the quality of care provided to their child(ren). Severity of illness and adaptive functioning were reliably associated with quality of childcare. Psychosocial support, substance abuse/dependence and parenting role had an indirect relationship to the outcome variable via their association with either severity of illness and/or adaptive functioning. CONCLUSION The majority of parents in the current sample provided adequate parenting. However, greater symptom severity and poorer adaptive functioning ultimately leave parents with significant difficulties and in need of assistance to manage their parenting obligations. As symptoms and functioning can change episodically for people with psychotic illness, provision of targeted and flexible support that can deliver temporary assistance during times of need is necessary. This would maximise the quality of care provided to vulnerable children, with potential long-term benefits.
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Affiliation(s)
| | | | - Cherrie A Galletly
- 2 School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,3 Discipline of Psychiatry, University of Adelaide Ramsay Health Care (SA) Mental Health Services Northern Adelaide Local Health Network, South Australia
| | - Carol Harvey
- 4 Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Helen Stain
- 5 School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | - Martin Cohen
- 1 The University of Newcastle, Newcastle, NSW, Australia
| | | | - Scott Brown
- 1 The University of Newcastle, Newcastle, NSW, Australia
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79
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Eglit GML, Palmer BW, Martin AS, Tu X, Jeste DV. Loneliness in schizophrenia: Construct clarification, measurement, and clinical relevance. PLoS One 2018; 13:e0194021. [PMID: 29566046 PMCID: PMC5863980 DOI: 10.1371/journal.pone.0194021] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/22/2018] [Indexed: 01/07/2023] Open
Abstract
Loneliness is a highly prevalent experience in schizophrenia. Theoretical models developed in the general population propose that loneliness is tantamount to a feeling of being unsafe, is accompanied by enhanced environmental threat perception, and leads to poor physical, emotional, and cognitive functioning. Previous research has reported that loneliness is associated with poorer physical and emotional health in schizophrenia; however, few studies have directly compared loneliness and its correlates in persons with schizophrenia and non-psychiatric comparison subjects. The purpose of the current study was to evaluate similarities and differences in the construct of loneliness, the equivalency of the measurement of this construct, and similarities and differences in the pattern of external correlates of loneliness between schizophrenia and non-psychiatric comparison groups. The third version of the University of California, Los Angeles Loneliness Scale (UCLA-3) was administered to 116 individuals with schizophrenia or schizoaffective disorder and 106 non-psychiatric comparison subjects. Additional clinical and positive psychological measures were collected, as well as demographic characteristics of the two groups. Multiple groups confirmatory factor analysis revealed that the UCLA-3 was best characterized by a bifactor model in which all items loaded on a general loneliness dimension as well as one of two orthogonal method factors reflecting item wording in both groups. Furthermore, the UCLA-3 exhibited invariant measurement of these latent constructs across groups. Mean levels of loneliness were nearly a standard deviation higher in the schizophrenia group. Nonetheless, the overall pattern and strength of correlates were largely similar across groups, with loneliness being positively associated with depression, anxiety, and perceived stress, and negatively correlated with mental well-being, happiness, and resilience. Subtle differences in correlates of age, optimism, and satisfaction with life were found. Overall, loneliness appears to be distinct from other schizophrenia-related deficits and operates similarly across schizophrenia and NC groups, suggesting that theoretical models of loneliness developed in the general population may generalize to schizophrenia.
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Affiliation(s)
- Graham M. L. Eglit
- Department of Psychiatry, University of California, San Diego, La Jolla, California, United States of America
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, California, United States of America
| | - Barton W. Palmer
- Department of Psychiatry, University of California, San Diego, La Jolla, California, United States of America
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, California, United States of America
- Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
| | - A’verria S. Martin
- Department of Psychiatry, University of California, San Diego, La Jolla, California, United States of America
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, California, United States of America
| | - Xin Tu
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, California, United States of America
| | - Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego, La Jolla, California, United States of America
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, California, United States of America
- Department of Neuroscience, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
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80
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Lim MH, Gleeson JFM, Alvarez-Jimenez M, Penn DL. Loneliness in psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2018; 53:221-238. [PMID: 29327166 DOI: 10.1007/s00127-018-1482-5] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/31/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of the review is to understand the relationships between loneliness and related psychological and social factors in individuals with psychosis. Loneliness is poorly understood in people with psychosis. Given the myriad of social challenges facing individuals with psychosis, these findings can inform psychosocial interventions that specifically target loneliness in this vulnerable group. METHODS We adhered to the PRISMA guidelines and systematically reviewed empirical studies that measured loneliness either as a main outcome or as an associated variable in individuals with psychosis. RESULTS A total of ten studies examining loneliness in people diagnosed with a psychotic disorder were examined. Heterogeneity in the assessment of loneliness was found, and there were contradictory findings on the relationship between loneliness and psychotic symptomatology. In individuals with psychosis, loneliness may be influenced by psychological and social factors such as increased depression, psychosis, and anxiety, poor social support, poor quality of life, more severe internalised stigma and perceived discrimination, and low self-esteem. CONCLUSIONS The relationship between loneliness and psychosis remains poorly understood due to a lack of rigorous studies. Although having strong social relationships is crucial to facilitate recovery from serious mental illness, psychosocial interventions that specifically target loneliness in individuals with psychosis are lacking and sorely needed. Interventions targeting loneliness in those with psychosis will also need to account for additional barriers associated with psychosis (e.g., social skill deficits, impoverished social networks, and negative symptoms).
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Affiliation(s)
- Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, 3122, Australia.
| | - John F M Gleeson
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David L Penn
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia.,Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
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81
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Abstract
Loneliness may be related to psychotic symptoms but a comprehensive synthesis of the literature in this area is lacking. The primary aim of the current study is to provide a systematic review and meta-analysis of the association between loneliness and psychotic symptoms in people with psychosis. A search of electronic databases was conducted (PsychINFO, MEDLINE, EMBASE, and Web of Science). A random effects meta-analysis was used to compute a pooled estimate of the correlation between loneliness and psychotic symptoms. Study and outcome quality were assessed using adapted versions of the Agency for Healthcare Research and Quality (AHRQ) tool and GRADE approach, respectively. Thirteen studies were included, providing data from 15 647 participants. A moderate association between psychosis and loneliness was observed (k = 13, N = 15 647, r = .32, 95% CI 0.20, 0.44; I2 = 97.56%; moderate quality evidence). Whether loneliness was assessed by a single-item or a more comprehensive measure had no moderating effect on the estimate. Results indicate that there is a significant positive relationship between loneliness and psychosis. Further studies are needed to determine the causal status of this relationship, but this robust finding should be considered in clinical practice and treatment provision for those with psychotic disorders.
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Affiliation(s)
| | - Stephen Rhodes
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, Edinburgh, UK
| | - Eleni Vasilopoulou
- Section of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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82
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Klug G, Toner S, Fabisch K, Priebe S. Characteristics and motivations of volunteers providing one-to-one support for people with mental illness: a survey in Austria. Soc Psychiatry Psychiatr Epidemiol 2018; 53:841-847. [PMID: 29651621 PMCID: PMC6061434 DOI: 10.1007/s00127-018-1514-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/09/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Large numbers of volunteers provide one-to-one support for people with mental illness, sometimes referred to as befriending. However, there has been very little research on their characteristics and motivations. This study aimed to assess the personal characteristics and motivations of such volunteers across different regions in Austria. METHODS Questionnaires assessing characteristics and motivations were distributed to 663 volunteers providing befriending for people with mental illness within volunteering programmes organised in four Austrian regions. RESULTS Questionnaires were completed and returned by 360 out of 663 approached volunteers (response rate 54%). Whilst most socio-demographic characteristics were widely distributed, 78% were female; 42% reported to have a family member and 56% a friend with a mental illness. Most volunteers cited motivations to do something both for others (e.g. "feel a responsibility to help others") and for themselves (e.g. "enhance my awareness of mental health issues"). When the total group was divided into four subgroups in a cluster analysis based on their socio-demographic characteristics, a subgroup of female, single and younger volunteers in full-time employment expressed motivations to achieve something for themselves significantly more often than other subgroups. CONCLUSIONS The study provides the largest sample of volunteers in befriending programmes for people with mental illness in the research literature to date. The findings suggest that people with different characteristics can be recruited to volunteer for befriending programmes. Recruitment strategies and supervision arrangements should consider motivations both to help others and to achieve something for themselves, and may be varied for specific volunteer subgroups.
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Affiliation(s)
- Gϋnter Klug
- Psychosocial Services, Society for Mental Health Promotion, Graz, Austria
| | - Sarah Toner
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK
| | - Karin Fabisch
- University Hospital for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Styria Austria
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK.
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83
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Gordon A, Davis PJ, Patterson S, Pepping CA, Scott JG, Salter K, Connell M. A randomized waitlist control community study of Social Cognition and Interaction Training for people with schizophrenia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 57:116-130. [DOI: 10.1111/bjc.12161] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/22/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Anne Gordon
- Metro North Mental Health; Royal Brisbane and Women’s Hospital Herston; Queensland Australia
| | - Penelope J. Davis
- School of Applied Psychology; Griffith University; Mt Gravatt Queensland Australia
| | - Susan Patterson
- Metro North Mental Health; Royal Brisbane and Women’s Hospital Herston; Queensland Australia
- School of Applied Psychology; Griffith University; Mt Gravatt Queensland Australia
| | | | - James G. Scott
- Queensland Centre for Mental Health Research; The Park Centre for Mental Health; Wacol Queensland Australia
- UQ Centre for Clinical Research; Faculty of Medicine; The Royal Brisbane and Women's Hospital; The University of Queensland; Herston Queensland Australia
| | - Kerri Salter
- Child Development Service; Gold Coast Community Health; Southport Queensland Australia
| | - Melissa Connell
- Metro North Mental Health; Royal Brisbane and Women’s Hospital Herston; Queensland Australia
- UQ Centre for Clinical Research; Faculty of Medicine; The Royal Brisbane and Women's Hospital; The University of Queensland; Herston Queensland Australia
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84
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Hanlon MC, Campbell LE, Single N, Coleman C, Morgan VA, Cotton SM, Stain HJ, Castle DJ. Men and women with psychosis and the impact of illness-duration on sex-differences: The second Australian national survey of psychosis. Psychiatry Res 2017. [PMID: 28633054 DOI: 10.1016/j.psychres.2017.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We aimed to examine and compare sex-differences in people receiving treatment for psychotic illnesses in community settings, based on long or short duration of illness; expecting association between longer illness-duration and worse outcomes in women and men. Clinical, demographic and service-use data from the Survey of High Impact Psychosis were analysed by sex and duration of illness (≤5 years; ≥6 years), using independent t-tests, chi-square tests, one-way ANOVA, and Cramer's V. Of the 1825 participants, 47% had schizophrenia, 17.5% bipolar and 16.1% schizo-affective disorders. More women than men had undertaken post-school education, maintained relationships, and been living in their own homes. Women with a shorter-illness-duration showed social functioning equivalent to non-ill women in the general population. Men tended to have an early illness onset, show premorbid dysfunction, be single, show severe disability, and to use illicit substances. Men with a longer-illness-duration were very socially disadvantaged and isolated, often experiencing homelessness and substance use. Men with a short-illness-duration were most likely to be in paid employment, but two-thirds earned less than $AUD500 per fortnight. Men with longer-illness-duration showed most disability, socially and globally. Interventions should be guided by diagnosis, but also by a person's sex and duration of illness.
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Affiliation(s)
- Mary-Claire Hanlon
- The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, NSW, Australia; Calvary Mater Newcastle, Waratah, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Linda E Campbell
- The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Priority Research Centre GrowUpWell and the School of Psychology, University of Newcastle, Australia
| | | | | | - Vera A Morgan
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, WA, Australia; North Metropolitan Health Service Mental Health, Perth, WA, Australia
| | - Susan M Cotton
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Helen J Stain
- Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, NSW, Australia; School of Social and Health Sciences, Leeds Trinity University, Horsforth, Leeds, UK
| | - David J Castle
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
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85
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Bowman S, McKinstry C, McGorry P. Youth mental ill health and secondary school completion in Australia: time to act. Early Interv Psychiatry 2017; 11:277-289. [PMID: 27381567 DOI: 10.1111/eip.12357] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/01/2016] [Indexed: 12/30/2022]
Abstract
AIM This paper reviews the evidence of youth mental ill health and its impact on secondary school educational attainment. METHODS This narrative review presents the current research related to the mental ill health of young people in urban and rural Australia, their educational attainment and the effectiveness of mental health strategies implemented in secondary schools. RESULTS The prevalence of mental ill health is high for Australian young people and the onset of depression, anxiety, substance-use disorders and first episode psychosis (FEP) commonly occurs when the individual is at school. The prevalence is reported to be higher for rural young people and barriers to treatment exist. Current evidence suggests that 40% of young people experiencing depression or anxiety disorders are not completing secondary school. Further evidence shows that over 50% of individuals who experience FEP do not finish secondary school. Current mental health promotion strategies employed in secondary schools have not been shown to reduce rates of depression or anxiety in adolescence nor identify prodromal or acute FEP. These strategies have not led to interventions that assist young people with mental ill health to finish school. CONCLUSIONS Not completing secondary school can limit employment options, lead to severe levels of disadvantage and increased burden on welfare and healthcare systems. All young people, including those in rural areas, have the right to education and should not be disadvantaged in their educational aspirations because they have an emerging or current mental illness.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, Community and Clinical Allied Health & LaTrobe Rural Health School, College of Science, Health and Engineering, LaTrobe University, Melbourne, Victoria, Australia
| | - Carol McKinstry
- Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Bendigo, Victoria, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
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86
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Butter S, Murphy J, Shevlin M, Houston J. Social isolation and psychosis-like experiences: a UK general population analysis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1349829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sarah Butter
- School of Psychology, Ulster University, Derry, UK
| | - Jamie Murphy
- School of Psychology, Ulster University, Derry, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, UK
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The lonely road to paranoia. A path-analytic investigation of loneliness and paranoia. Compr Psychiatry 2017; 74:35-43. [PMID: 28092774 DOI: 10.1016/j.comppsych.2016.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/16/2016] [Accepted: 12/28/2016] [Indexed: 02/06/2023] Open
Abstract
Loneliness and paranoia are related, but the mechanisms that link them to each other remain unclear. Systematic reviews on loneliness propose a social-cognitive model in which loneliness leads to negative evaluations of other persons and a lack of interpersonal trust. However, the data discussed in these reviews are based on healthy individuals. Building on this model, the present study investigated 1) whether negative interpersonal schemata mediate the association between loneliness and paranoia and 2) whether a low level of perceived social support and less frequent social contact are related to loneliness. Using a cross-sectional design, sixty-five participants with a diagnosis of schizophrenia were recruited online and completed questionnaire-based measures of loneliness, paranoia, negative interpersonal schemata, perceived social support and frequency of social contact. Data were analyzed taking a path-analytic approach. The association between loneliness and paranoia was significantly and fully mediated by negative schemata of others. Moreover, a low level of perceived social support was significantly associated with loneliness, whereas self-reported frequency of social contact was not. The present results highlight the potential role of interpersonal negative schemata in the formation and maintenance of paranoia and elucidate the crucial role of loneliness in the way individuals construe themselves within a social environment.
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88
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Lamster F, Nittel C, Rief W, Mehl S, Lincoln T. The impact of loneliness on paranoia: An experimental approach. J Behav Ther Exp Psychiatry 2017; 54:51-57. [PMID: 27362838 DOI: 10.1016/j.jbtep.2016.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 06/03/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Loneliness is a common problem in patients with schizophrenia, and may be particularly linked with persecutory ideation. Nevertheless, its role as a potential risk factor in the formation and maintenance of persecutory delusions is largely unexplored. METHODS Loneliness was experimentally manipulated using a false-feedback paradigm in a non-clinical sample (n = 60). Change in state paranoia was compared between the induction of increased loneliness, the induction of reduced loneliness and a control condition. Distinct associations between pre-post scores of loneliness and state paranoia were examined at three (medium/high/low) levels of proneness to psychosis across the experimental conditions. RESULTS Reduction of loneliness was associated with a significant reduction of present paranoid beliefs, while induction of loneliness lead to more pronounced paranoia on trend significance level. Moreover, proneness to psychosis significantly moderated the impact of loneliness on paranoia. Persons with a pronounced level of proneness to psychosis showed a stronger reduction of paranoid beliefs as a consequence of a decrease in loneliness, than less prone individuals. LIMITATIONS A limitation is the small size of our sample, which may have limited the power to detect significant within-group changes in state paranoia in the high-loneliness condition and changes in loneliness in the low-loneliness condition. CONCLUSIONS The findings support the feasibility of the experimental design to manipulate loneliness and suggest that loneliness could be a cause of paranoia. However, the findings need to be confirmed in high risk samples to draw conclusions about the role of loneliness in the genesis of clinically relevant levels of paranoia and derive implications for cognitive behaviour therapy.
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Affiliation(s)
- Fabian Lamster
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-University Marburg, Gutenbergstr. 18, 35032 Marburg, Germany.
| | - Clara Nittel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Philipps-University Marburg, Rudolf-Bultmannstr. 8, 35037 Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-University Marburg, Gutenbergstr. 18, 35032 Marburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Philipps-University Marburg, Rudolf-Bultmannstr. 8, 35037 Marburg, Germany; Department of Social Work and Health, Frankfurt University of Applied Science, Nibelungenplatz 1, 60143 Frankfurt am Main, Germany
| | - Tania Lincoln
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, University Hamburg, von-Melle-Park 5, 20146 Hamburg, Germany
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Morgan VA, Waterreus A, Carr V, Castle D, Cohen M, Harvey C, Galletly C, Mackinnon A, McGorry P, McGrath JJ, Neil AL, Saw S, Badcock JC, Foley DL, Waghorn G, Coker S, Jablensky A. Responding to challenges for people with psychotic illness: Updated evidence from the Survey of High Impact Psychosis. Aust N Z J Psychiatry 2017; 51:124-140. [PMID: 27913580 DOI: 10.1177/0004867416679738] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective is to summarise recent findings from the 2010 Australian Survey of High Impact Psychosis (SHIP) and examine their implications for future policy and planning to improve mental health, physical health and other circumstances of people with a psychotic disorder. METHODS Survey of High Impact Psychosis collected nationally representative data on 1825 people with psychotic illness. Over 60 papers have been published covering key challenges reported by participants: financial problems, loneliness and social isolation, unemployment, poor physical health, uncontrolled symptoms of mental illness, and lack of stable, suitable housing. Findings are summarised under the rubric of participant-ranked top challenges. RESULTS The main income source for the majority (85%) of participants was a government benefit. Only one-third was employed, and the most appropriate employment services for this group were under-utilised. High rates of loneliness and social isolation impacted mental and physical health. The rate of cardiometabolic disease was well above the general population rate, and associated risk factors were present from a very young age. Childhood abuse (30.6%), adult violent victimisation (16.4%) and alcohol and substance abuse/dependence (lifetime rates of 50.5% and 54.5%, respectively) complicated the clinical profile. Treatment with medication was suboptimal, with physical health conditions undertreated, a high rate of psychotropic polypharmacy and underutilisation of clozapine in chronic persistent psychotic illness. Only 38.6% received evidence-based psychosocial therapies. In the previous year, 27.4% had changed housing and 12.8% had been homeless, on average for 155 days. CONCLUSION Money, social engagement and employment are the most important challenges for people with psychotic illness, as well as good physical and mental health. An integrated approach to recovery is needed to optimise service delivery and augment evidence-based clinical practice with measures to improve physical health and social circumstances. Meeting these challenges has the potential to reduce costs to government and society, as well as promote recovery.
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Affiliation(s)
- Vera A Morgan
- 1 Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.,2 Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - Anna Waterreus
- 1 Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - Vaughan Carr
- 3 Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,4 Schizophrenia Research Institute and Neuroscience Research Australia, Sydney, NSW, Australia.,5 Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - David Castle
- 6 St Vincent's Hospital, Melbourne, VIC, Australia.,7 Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Martin Cohen
- 8 Hunter New England Mental Health, Newcastle, NSW, Australia.,9 The University of Newcastle, Newcastle, NSW, Australia
| | - Carol Harvey
- 7 Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Cherrie Galletly
- 10 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,11 Ramsay Health Care, Mental Health Services, Adelaide, SA, Australia.,12 Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Andrew Mackinnon
- 13 Black Dog Institute and University of New South Wales, Sydney, NSW Australia.,14 Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Patrick McGorry
- 15 Orygen Youth Health Research Centre, Melbourne, VIC, Australia
| | - John J McGrath
- 16 Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia.,17 Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Amanda L Neil
- 18 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Suzy Saw
- 19 Health Data Analysis Pty Ltd, Canberra, ACT, Australia
| | - Johanna C Badcock
- 2 Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.,20 Cooperative Research Centre-Mental Health, Carlton, VIC, Australia
| | - Debra L Foley
- 21 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Geoff Waghorn
- 17 Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Sarah Coker
- 22 SANE Australia, Melbourne, VIC, Australia
| | - Assen Jablensky
- 2 Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.,20 Cooperative Research Centre-Mental Health, Carlton, VIC, Australia
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90
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Mucheru D, Hanlon MC, Campbell LE, McEvoy M, MacDonald-Wicks L. Social Dysfunction and Diet Outcomes in People with Psychosis. Nutrients 2017; 9:nu9010080. [PMID: 28106815 PMCID: PMC5295124 DOI: 10.3390/nu9010080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/26/2016] [Accepted: 01/11/2017] [Indexed: 11/16/2022] Open
Abstract
This analysis aimed to examine the association of social dysfunction with food security status, fruit intake, vegetable intake, meal frequency and breakfast consumption in people with psychosis from the Hunter New England (HNE) catchment site of the Survey of High Impact Psychosis (SHIP). Social dysfunction and dietary information were collected using standardised tools. Independent binary logistic regressions were used to examine the association between social dysfunction and food security status, fruit intake, vegetable intake, meal frequency and breakfast consumption. Although social dysfunction did not have a statistically significant association with most diet variables, participants with obvious to severe social dysfunction were 0.872 (95% CI (0.778, 0.976)) less likely to eat breakfast than those with no social dysfunction p < 0.05. Participants with social dysfunction were therefore, 13% less likely to have breakfast. This paper highlights high rates of social dysfunction, significant food insecurity, and intakes of fruits and vegetables below recommendations in people with psychosis. In light of this, a greater focus needs to be given to dietary behaviours and social dysfunction in lifestyle interventions delivered to people with psychosis. Well-designed observational research is also needed to further examine the relationship between social dysfunction and dietary behaviour in people with psychosis.
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MESH Headings
- Adolescent
- Adult
- Australia
- Breakfast
- Cohort Studies
- Cross-Sectional Studies
- Diet, Healthy/economics
- Diet, Healthy/psychology
- Feeding Behavior/psychology
- Female
- Food Supply/economics
- Humans
- Male
- Middle Aged
- Nutrition Surveys
- Patient Compliance/psychology
- Phobia, Social/economics
- Phobia, Social/etiology
- Phobia, Social/prevention & control
- Phobia, Social/psychology
- Psychotic Disorders/economics
- Psychotic Disorders/physiopathology
- Psychotic Disorders/psychology
- Psychotic Disorders/therapy
- Retrospective Studies
- Social Behavior Disorders/economics
- Social Behavior Disorders/etiology
- Social Behavior Disorders/prevention & control
- Social Behavior Disorders/psychology
- Social Isolation/psychology
- Socioeconomic Factors
- Stress, Psychological/economics
- Stress, Psychological/etiology
- Stress, Psychological/prevention & control
- Stress, Psychological/psychology
- Young Adult
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Affiliation(s)
- Doreen Mucheru
- Faculty Health and Medicine, The University of Newcastle, Callaghan 2308, Australia.
| | - Mary-Claire Hanlon
- Faculty Health and Medicine, The University of Newcastle, Callaghan 2308, Australia.
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton 2305, Australia.
- Priority Research Centre for Brain and Mental Health, Mater Hospital, Waratah 2298, Australia.
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah 2298, Australia.
- Hunter Cancer Research Alliance, The University of Newcastle, Callaghan 2308, Australia.
| | - Linda E Campbell
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton 2305, Australia.
- Faculty of Science, The University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre GrowUpWell, The University of Newcastle, Callaghan 2308, Australia.
| | - Mark McEvoy
- Faculty Health and Medicine, The University of Newcastle, Callaghan 2308, Australia.
- Centre for Clinical Epidemiology & Biostatistics, Hunter Medical Research Institute, New Lambton 2305, Australia.
| | - Lesley MacDonald-Wicks
- Faculty Health and Medicine, The University of Newcastle, Callaghan 2308, Australia.
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton 2305, Australia.
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan 2308, Australia.
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91
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Linz SJ, Sturm BA. Facilitating Social Integration for People With Severe Mental Illness Served by Assertive Community Treatment. Arch Psychiatr Nurs 2016; 30:692-699. [PMID: 27888961 DOI: 10.1016/j.apnu.2016.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/18/2016] [Accepted: 05/29/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE This article explores the experience of workers on Assertive Community Treatment (ACT) teams surrounding their efforts to facilitate social integration for their clients. DESIGN AND METHODS Sixteen workers were individually interviewed and eight additional workers participated in two focus groups. FINDINGS The formation of caring relationships between worker and client was an important first step towards social integration for ACT clients. Community activities offer opportunities for social interaction. PRACTICE IMPLICATIONS The frequency of community based activities should be increased. Social integration should be a targeted focus of service by structurally embedding a social integration specialist onto the ACT model.
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Affiliation(s)
- Sheila J Linz
- The Rutgers University School of Nursing, Camden, NJ.
| | - Bonnie A Sturm
- Seton Hall University College of Nursing, South Orange, NJ
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92
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Bowman S, McGorry P. The student safety net: a new angle for early intervention. Early Interv Psychiatry 2016; 10:279-81. [PMID: 27027719 DOI: 10.1111/eip.12339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/15/2016] [Accepted: 02/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, Community and Clinical Allied Health and La Trobe Rural Health School, College of Science, Health and Engineering, Latrobe University, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
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93
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Badcock JC, Barkus E, Cohen AS, Bucks R, Badcock DR. Loneliness and Schizotypy Are Distinct Constructs, Separate from General Psychopathology. Front Psychol 2016; 7:1018. [PMID: 27458412 PMCID: PMC4935680 DOI: 10.3389/fpsyg.2016.01018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/21/2016] [Indexed: 11/13/2022] Open
Abstract
Loneliness is common in youth and associated with a significantly increased risk of psychological disorders. Although loneliness is strongly associated with psychosis, its relationship with psychosis proneness is unclear. Our aim in this paper was to test the hypothesis that loneliness and schizotypal traits, conveying risk for schizophrenia spectrum disorders, are similar but separate constructs. Pooling data from two non-clinical student samples (N = 551) we modeled the structure of the relationship between loneliness and trait schizotypy. Loneliness was assessed with the University of California, Los Angeles Loneliness Scale (UCLA-3), whilst negative (Social Anhedonia) and positive (Perceptual Aberrations) schizotypal traits were assessed with the Wisconsin Schizotypy Scales-Brief (WSS-B). Fit statistics indicated that the best fitting model of UCLA-3 scores comprises three correlated factors (Isolation, Related Connectedness, and Collective Connectedness), consistent with previous reports. Fit statistics for a two factor model of positive and negative schizotypy were excellent. Next, bi-factor analysis was used to model a general psychopatholgy factor (p) across the three loneliness factors and separate negative and positive schizotypy traits. The results showed that all items (except 1) co-loaded on p. However, with the influence of p removed, additional variance remained within separate sub-factors, indicating that loneliness and negative and positive trait schizotypy are distinct and separable constructs. Similarly, once shared variance with p was removed, correlations between sub-factors of loneliness and schizotypal traits were non-significant. These findings have important clinical implications since they suggest that loneliness should not be conflated with the expression of schizotypy. Rather, loneliness needs to be specifically targeted for assessment and treatment in youth at risk for psychosis.
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Affiliation(s)
- Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia Perth, WA, Australia
| | - Emma Barkus
- School of Psychology, University of Wollongong Wollongong, NSW, Australia
| | - Alex S Cohen
- Department of Psychology, Lousiana State University Baton Rouge, LA, USA
| | - Romola Bucks
- School of Psychology, The University of Western Australia Crawley, WA, Australia
| | - David R Badcock
- School of Psychology, The University of Western Australia Crawley, WA, Australia
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94
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Abstract
OBJECTIVE Recognizing that needs differ between men and women with schizophrenia and that they vary over time, this review attempts to categorize the needs that are relevant to younger and to older women. METHOD This is a selective literature review focusing on topic areas the two authors determined to be most germane to women with schizophrenia. Articles were selected on the basis of currency, comprehensiveness, and study design. Particular attention was paid to the voices of the women themselves. RESULTS There is considerable overlap between the needs of younger and older women with schizophrenia, but as a general rule, younger women require preventive strategies to stop the escalation of illness while older women require recovery interventions to regain lost hopes and abilities. CONCLUSIONS There is clinical utility in cataloguing the needs of younger and older women with schizophrenia and conceptualizing interventions according to gender and age rather than viewing needed services along purely diagnostic lines.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Rina Gupta
- North East London Foundation Trust, Goodmayes Hospital, Ilford, Essex, UK
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95
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Structure of the Social Support Network of Patients with Severe and Persistent Psychiatric Disorders in Follow-Ups to Primary Health Care. Arch Psychiatr Nurs 2016; 30:70-6. [PMID: 26804504 DOI: 10.1016/j.apnu.2015.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/29/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
The objective of this study is to analyze the characteristics of social support networks of patients with psychiatric disorders at follow-up to primary care. This is a cross-sectional qualitative research study. Forty-five interviews were held with patients and their supporters. The results showed small and dense networks, with a strong emphasis on the bonds with formal supporters and a scant network of informal supporters. It is recommended to develop strategies to improve social support networks and use this as an outcome indicator related to social integration of these patients and to the quality of services involved with outpatient healthcare.
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96
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Badcock JC, Shah S, Mackinnon A, Stain HJ, Galletly C, Jablensky A, Morgan VA. Loneliness in psychotic disorders and its association with cognitive function and symptom profile. Schizophr Res 2015; 169:268-273. [PMID: 26527247 DOI: 10.1016/j.schres.2015.10.027] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Loneliness involves subjective, rather than objective, social isolation and has a range of negative effects on mental and physical functioning. The purpose of this study was to examine the prevalence of loneliness in psychotic disorders and its association with symptoms and cognitive performance. METHOD Data were drawn from the second Australian National Survey of Psychosis and comprised responses from 1642 participants with an International Classification of Diseases 10 diagnosis of psychotic disorder who had completed a semi-structured interview of symptoms and social functioning (including loneliness), along with standardized assessments of current (digit symbol coding; DSC) and premorbid (National Adult Reading Test) cognitive ability. We examined the prevalence of loneliness across the diagnostic categories of psychosis, and its association with psychotic and non-psychotic symptoms and digit symbol coding scores. RESULTS The prevalence of loneliness was high, ranging from 74.75% in participants with delusional disorders to 93.8% in depressive psychosis, and was significantly higher than in the general population. Loneliness was also significantly associated with anhedonia and subjective thought disorder. Participants feeling socially isolated/lonely for company had significantly lower DSC scores than those who only felt lonely occasionally. Unexpectedly, participants who reported not feeling lonely had the lowest DSC scores. CONCLUSIONS Loneliness is common across all psychotic disorders, particularly in depressive psychosis. It is specifically associated with ongoing loss of pleasure and disordered thoughts as well as impairment in current cognitive functioning. However, poor cognitive functioning is not inevitably associated with loneliness. Implications for personalized treatment of psychosis are discussed.
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Affiliation(s)
- Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Medical Research Foundation Building, Rear 50 Murray Street, Perth 6000, Australia; Cooperative Research Centre - Mental Health, Barry Street, Carlton, Victoria 3052, Australia.
| | - Sonal Shah
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Medical Research Foundation Building, Rear 50 Murray Street, Perth 6000, Australia.
| | - Andrew Mackinnon
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria 3052, Australia.
| | - Helen J Stain
- Mental Health Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-On-Tees TS17 6BH, United Kingdom.
| | - Cherrie Galletly
- School of Medicine, University of Adelaide, Ramsay Health Care (SA) Mental Health, Northern Adelaide Local Health Network, 33 Park Terrace, Gilberton, South Australia 5081, Australia; Ramsay Health Care (SA) Mental Health, Australia; Northern Adelaide Local Health Network, Australia.
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Medical Research Foundation Building, Rear 50 Murray Street, Perth 6000, Australia.
| | - Vera A Morgan
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Medical Research Foundation Building, Rear 50 Murray Street, Perth 6000, Australia; Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Medical Research Foundation Building, Rear 50 Murray Street, Perth 6000, Australia.
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97
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Gliddon E, Lauder S, Berk L, Cosgrove V, Grimm D, Dodd S, Suppes T, Berk M. Evaluating discussion board engagement in the MoodSwings online self-help program for bipolar disorder: protocol for an observational prospective cohort study. BMC Psychiatry 2015; 15:243. [PMID: 26462799 PMCID: PMC4604761 DOI: 10.1186/s12888-015-0630-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Online, self-guided programs exist for a wide range of mental health conditions, including bipolar disorder, and discussion boards are often part of these interventions. The impact engagement with these discussion boards has on the psychosocial well-being of users is largely unknown. More specifically we need to clarify the influence of the type and level of engagement on outcomes. The primary aim of this exploratory study is to determine if there is a relationship between different types (active, passive or none) and levels (high, mid and low) of discussion board engagement and improvement in outcome measures from baseline to follow up, with a focus on self-reported social support, stigma, quality of life and levels of depression and mania. The secondary aim of this study is to identify any differences in demographic variables among discussion users. METHODS/DESIGN The present study is a sub-study of the MoodSwings 2.0 3-arm randomised controlled trial (discussion board only (arm 1), discussion board plus psychoeducation (arm 2), discussion board, psychoeducation plus cognitive behavioural therapy-based tools (arm 3)). Discussion engagement will be measured via online participant activity monitoring. Assessments include online self-report as well as blinded phone interviews at baseline, 3, 6, 9 and 12 months follow up. DISCUSSION The results of this study will help to inform future programs about whether or not discussion boards are a beneficial inclusion in online self-help interventions. It will also help to determine if motivating users to actively engage in online discussion is necessary, and if so, what level of engagement is optimal to produce the most benefit. Future programs may benefit through being able to identify those most likely to poorly engage, based on demographic variables, so motivational strategies can be targeted accordingly. TRIAL REGISTRATION ClinicalTrials.gov NCT02118623 registered April 15 2014 and NCT02106078 registered May 16 2013.
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Affiliation(s)
- Emma Gliddon
- IMPACT Strategic Research Centre, Deakin University, Geelong, Australia. .,The Department of Psychiatry, The University of Melbourne, Parkville, Australia.
| | - Sue Lauder
- The Department of Psychiatry, The University of Melbourne, Parkville, Australia. .,The Collaborative Research Network, Federation University, Ballarat, Australia.
| | - Lesley Berk
- The Department of Psychiatry, The University of Melbourne, Parkville, Australia. .,Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Australia. .,School of Psychology, Deakin University, Burwood, Australia.
| | - Victoria Cosgrove
- VA Palo Alto Health Care System, Palo Alto, California, USA. .,Stanford University School of Medicine, Stanford, California, USA.
| | - David Grimm
- VA Palo Alto Health Care System, Palo Alto, California, USA.
| | - Seetal Dodd
- IMPACT Strategic Research Centre, Deakin University, Geelong, Australia. .,The Department of Psychiatry, The University of Melbourne, Parkville, Australia.
| | - Trisha Suppes
- VA Palo Alto Health Care System, Palo Alto, California, USA. .,Stanford University School of Medicine, Stanford, California, USA.
| | - Michael Berk
- IMPACT Strategic Research Centre, Deakin University, Geelong, Australia. .,The Department of Psychiatry, The University of Melbourne, Parkville, Australia. .,Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, Australia. .,Florey Institute for Neuroscience and Mental Health, Parkville, Australia.
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98
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Coker F, Williams A, Hayes L, Hamann J, Harvey C. Exploring the needs of diverse consumers experiencing mental illness and their families through family psychoeducation. J Ment Health 2015; 25:197-203. [PMID: 26398121 DOI: 10.3109/09638237.2015.1057323] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Family psychoeducation (FPE), an intervention for those experiencing serious mental illness and their families, aims to improve communication and build problem-solving skills. Limited research exists on carers' and consumers' needs who engage in FPE, or FPE's impact on needs. AIMS This study aimed to describe the needs of consumers with mental illness and their carers, who participated in behavioural family therapy (BFT), a type of FPE, and evaluate changes to needs. METHOD Qualitative responses to the Carers' and Users' Expectations of Services questionnaires were analysed to describe consumers' and carers' needs. Participants' quantitative responses were analysed using descriptive statistics, to evaluate changes in needs post-programme. RESULTS Participants' needs included information on mental illness and improved relationships. Post-programme, the percentage of consumers' satisfied with their lives increased, while the percentage of carers' reporting a need for more assistance decreased. CONCLUSIONS Further development of BFT programmes in clinical and non-clinical services is warranted to address the needs of diverse consumers and carers living in the community.
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Affiliation(s)
- Freya Coker
- a Department of Psychiatry , Psychosocial Research Centre, University of Melbourne , Melbourne , Australia .,b Department of Occupational Therapy, Faculty of Health Sciences , La Trobe University , Melbourne , Australia , and
| | - Anne Williams
- b Department of Occupational Therapy, Faculty of Health Sciences , La Trobe University , Melbourne , Australia , and
| | - Laura Hayes
- a Department of Psychiatry , Psychosocial Research Centre, University of Melbourne , Melbourne , Australia
| | | | - Carol Harvey
- a Department of Psychiatry , Psychosocial Research Centre, University of Melbourne , Melbourne , Australia
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99
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Duhig M, Patterson S, Connell M, Foley S, Capra C, Dark F, Gordon A, Singh S, Hides L, McGrath JJ, Scott J. The prevalence and correlates of childhood trauma in patients with early psychosis. Aust N Z J Psychiatry 2015; 49:651-9. [PMID: 25722463 DOI: 10.1177/0004867415575379] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To describe the prevalence and demographic, clinical and functional correlates of childhood trauma in patients attending early psychosis clinics. METHOD Participants were recruited from outpatients attending four early psychosis services. Exposure to childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Psychopathology was measured using the Positive and Negative Syndrome Scale and the Depression, Anxiety and Stress Scale. Social and vocational functioning and substance use were also assessed. RESULTS Over three-quarters of the 100 patients reported exposure to any childhood trauma. Emotional, physical and sexual abuse were reported by 54%, 23% and 28% of patients, respectively, while 49% and 42% of patients reported emotional and physical neglect, respectively. Female participants were significantly more likely to be exposed to emotional and sexual abuse. Exposure to childhood trauma was correlated with positive psychotic symptoms and higher levels of depressive, anxiety and stress symptoms; however, it had no impact on social or vocational functioning or recent substance use. CONCLUSION Exposure to childhood trauma was common in patients with early psychosis, and associated with increased symptomatology. Existing recommendations that standard clinical assessment of patients with early psychosis should include inquiry into exposure to childhood trauma are supported.
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Affiliation(s)
- Michael Duhig
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia The University of Queensland Centre for Clinical Research, Herston, QLD, Australia School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Sue Patterson
- Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Melissa Connell
- The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - Sharon Foley
- Metro South Mental Health, Princess Alexandra Hospital, Wooloongabba, QLD, Australia
| | - Carina Capra
- Metro South Mental Health, Princess Alexandra Hospital, Wooloongabba, QLD, Australia
| | - Frances Dark
- Metro South Mental Health, Princess Alexandra Hospital, Wooloongabba, QLD, Australia
| | - Anne Gordon
- Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Saveena Singh
- Early Psychosis Service, Gold Coast Health Service District, Burleigh Heads, Gold Coast, QLD, Australia
| | - Leanne Hides
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, QLD, Australia Institute of Health and Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - John J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - James Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia The University of Queensland Centre for Clinical Research, Herston, QLD, Australia Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia Discipline of Psychiatry, University of Queensland, St Lucia, QLD, Australia
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Rebgetz S, Kavanagh DJ, Hides L. Can exploring natural recovery from substance misuse in psychosis assist with treatment? A review of current research. Addict Behav 2015; 46:106-12. [PMID: 25839714 DOI: 10.1016/j.addbeh.2015.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 02/13/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
Substance misuse in people with psychosis presents significant problems, but trials of treatments to address it show little sustained advantage over control conditions. An examination of mechanisms underpinning unassisted improvements may assist in the refinement of comorbidity treatments. This study reviewed existing research on natural recovery from substance misuse in people with psychosis. To address this issue, a systematic search identified only 7 articles that fulfilled the criteria. Their results suggest that people with psychosis report similar reasons to change as do non-psychotic groups, although they did not clarify whether the relative frequencies or priority orders were the same. Differences involved issues relating to the disorder and the functional problems faced by this group: receipt of treatment for mental health difficulties, worsening of mental health difficulties, and homelessness. The current research on reasons for change in people with psychosis is sparse and has significant limitations, and as yet it offers little inspiration for new treatments. A more fertile source may prove to be a detailed investigation of successful substance control strategies that are used in self-management by this group.
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