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Munson MR, Jaccard JJ, Scott LD, Narendorf SC, Moore KL, Jenefsky N, Cole A, Davis M, Gilmer T, Shimizu R, Pleines K, Cooper K, Rodwin AH, Hylek L, Amaro A. Engagement intervention versus treatment as usual for young adults with serious mental illness: a randomized pilot trial. Pilot Feasibility Stud 2020; 6:107. [PMID: 32714561 PMCID: PMC7376671 DOI: 10.1186/s40814-020-00650-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/16/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Young adults have elevated rates of mental health disorders, yet they often do not receive consistent care. The challenge of continuing to engage young adults has been pervasive worldwide. Few engagement interventions have been designed for young adults with serious mental illness. Just Do You is a theoretically guided engagement intervention. It uses innovative modalities (i.e., technology, expressive arts activities, narrative expression, mentoring) to engage participants in conversations about services and how they work, while simultaneously orienting them to treatment. METHODS/DESIGN This pilot and feasibility study utilizes a hybrid research design, examining feasibility, acceptability, and preliminary impact, alongside implementation. The study combines qualitative methods, a small pilot randomized trial, and a small cost-benefit analysis. Respondents are clinic staff and young adults who have made initial contact with the Personalized Recovery Oriented Services (PROS) program. Quantitative survey data are collected at baseline, 2 weeks (post-intervention), 1 month, and 3 months. The assessments focus on measuring feasibility, acceptability, engagement, and mental health outcomes. Medical record extraction will be used to triangulate self-report data. We will conduct single degree of freedom contrasts to examine whether Just Do You leads to improved outcomes relative to Treatment-As-Usual using robust regression for each outcome measure. We will examine whether changes in the proposed mediating variables occur across groups using a similar contrast strategy. In addition, we will use structural equation modeling to examine the contribution of mediators to ultimate outcomes. Finally, we will use constant comparison coding techniques for qualitative analyses. DISCUSSION The aim of this study is to examine the feasibility of a young adult engagement meta-intervention through an intensive preliminary pilot trial, learning through collaboration with stakeholders. Just Do You has the potential to fill a gap in the service system for young adults with serious mental illnesses, improving the seemingly intractable problem of disengagement. The program uses culturally responsive strategies, is recovery-oriented, and builds upon the best evidence to date. Our efforts align with local and national health care reform efforts embedding people with lived experience. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov (Identifier: NCT03423212) on April 18, 2018, as Protocol Record R34 MH111861-01, New York University, as the Just Do You Program for Young Adults with Serious Mental Illness.
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Affiliation(s)
- Michelle R. Munson
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003 USA
| | - James J. Jaccard
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003 USA
| | - Lionel D. Scott
- School of Social Work, Georgia State University, Atlanta, Georgia 30302 USA
| | - Sarah C. Narendorf
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX 77204 USA
| | - Kiara L. Moore
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003 USA
| | - Nadia Jenefsky
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003 USA
| | - Andrea Cole
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Maryann Davis
- Medical School, Psychiatry, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Todd Gilmer
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA 92093 USA
| | - Rei Shimizu
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003 USA
| | - Kristin Pleines
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003 USA
| | - Kamilyah Cooper
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003 USA
| | - Aaron H. Rodwin
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003 USA
| | - Lindsay Hylek
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003 USA
| | - Angel Amaro
- School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY 10027 USA
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202
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Nathan R, Lewis E. Assessment of coexisting psychosis and substance misuse: complexities, challenges and causality. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2020.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYSubstance misuse worsens the prognosis for people suffering psychosis and places them at risk of being denied appropriate mental health service interventions. To increase the chances of its success, the plan of management for patients with coexisting psychosis and substance misuse should be based on a valid formulation of their problems, which in turn is dependent on the clinician having (a) a thorough understanding of the bidirectional and changing ways that substance use and mental illness symptoms can interact, (b) an awareness of their own biased implicit assumptions about causality in explaining these interactions and (c) a framework for assessment and formulation. This article addresses these three areas with reference to the evidence base and to clinical experience in a way that guides mental health clinicians in the assessment of patients with coexisting psychosis and substance misuse.
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203
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Miu AS, Vo HT, Palka JM, Glowacki CR, Robinson RJ. Teletherapy with serious mental illness populations during COVID-19: telehealth conversion and engagement. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1791800] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Adriana S. Miu
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hoa T. Vo
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jayme M. Palka
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Reed J. Robinson
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Race, History of Abuse, and Homelessness Are Associated With Forced Medication Administration During Psychiatric Inpatient Care. J Psychiatr Pract 2020; 26:294-304. [PMID: 32692126 DOI: 10.1097/pra.0000000000000485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although previous research has suggested that racial disparities exist in the administration of forced medication (FM) in psychiatric inpatients, data remain scarce regarding other contributing variables. Therefore, this study examined sociodemographic and clinical variables associated with FM administration in psychiatric inpatients. METHODS Electronic medical records from 57,615 patients admitted to an academic psychiatric hospital between 2010 and 2018 were reviewed to identify patients who received FM. These records indicated that FM petitions were requested and approved for ∼6200 patients. Patients were excluded from the analysis if they met the following exclusion criteria: under 18 years of age, presence of intellectual/developmental disability, dementia, or other neurological condition, or primary diagnosis of a nonpsychiatric medical condition or a substance-induced mood or psychotic disorder. After data on those patients were excluded, the final sample included records from 2569 patients (4.5% of the total records) in which the administration of FM was petitioned for and approved. The FM group was compared with a control group of 2569 patients matched in terms of age, sex, and admission date (no-forced medication group; NFM) via propensity scoring matching. Group comparisons (FM vs. NFM group) examined sociodemographic factors (race, age, sex, living situation), clinical features (diagnosis, substance abuse, history of abuse), and outcomes (length of stay, readmission rate). Regression analyses examined the association between FM and sociodemographic, clinical, and outcome variables. RESULTS Compared with the NFM group, the FM group contained significantly more African Americans (P<0.001), homeless individuals (P<0.001), and individuals with histories of abuse (P<0.001). Having received FM was a significant predictor of a longer length of stay (P<0.001) and higher readmission rates (P<0.001). DISCUSSION These results suggest that FM is more likely to be instituted in psychiatric inpatients who are of a minority race (African American), are in a homeless living situation, and/or have a history of abuse. Moreover, FM may be associated with poorer clinical outcomes at least as measured by the length of stay and higher readmission rates. We discuss possible reasons for these results and the importance of culturally competent and trauma-focused care.
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205
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Discharge and post-discharge outcomes of psychiatric inpatients with a lifetime history of exposure to interpersonal trauma: A population-based study. Gen Hosp Psychiatry 2020; 65:82-90. [PMID: 32544716 DOI: 10.1016/j.genhosppsych.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine discharge and post-discharge outcomes for psychiatric inpatients with a history of exposure to physical, sexual, or emotional trauma. METHODS In this population-based cohort study using health-administrative data, adult psychiatric inpatients in Ontario, Canada (2009-2016) with and without self-reported lifetime exposure to interpersonal trauma were compared on their likelihood of: discharge against medical advice; post-discharge outpatient follow-up; and post-discharge emergency department (ED) visits, rehospitalization, deliberate self-harm and suicide. Modified Poisson regressions generated relative risks (aRR) and 95% confidence intervals (CI), adjusted for age, sex, income, medical comorbidities, and psychiatric diagnosis. RESULTS Psychiatric inpatients with a history of interpersonal trauma (n = 50,832/160,436, 31.7%) were at elevated risk for discharge against medical advice (5.6% vs. 4.6%; aRR = 1.27, 1.21-1.33), and for 1-year post-discharge psychiatric ED visits (31.0% vs. 28.3%, aRR = 1.04, 1.02-1.06), and deliberate self-harm (5.5% vs. 3.7%, aRR = 1.30, 1.23-1.36). Post-discharge 30-day follow-up with primary care was slightly more common among those with a trauma history (37.6% vs. 34.5%, aRR = 1.06, 1.04-1.08); psychiatrist follow-up was less common (35.1% vs. 37.1%, aRR = 0.87, 0.86-0.89). Elevations in risk were observed for those with primary diagnoses of psychotic, mood and anxiety disorders, but not for those with a primary diagnosis of substance-related disorders. Risk elevations were specifically observed in those without a diagnosis of post-traumatic stress disorder. CONCLUSION Implementing supports and services during and after inpatient hospitalization that take into account a history of interpersonal trauma may help reduce certain undesirable discharge and post-discharge outcomes in this slightly higher-risk group.
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206
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Allott K, Steele P, Boyer F, de Winter A, Bryce S, Alvarez-Jimenez M, Phillips L. Cognitive strengths-based assessment and intervention in first-episode psychosis: A complementary approach to addressing functional recovery? Clin Psychol Rev 2020; 79:101871. [DOI: 10.1016/j.cpr.2020.101871] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/14/2022]
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207
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Roche E, O'Sullivan R, Gunawardena S, Cannon M, Lyne JP. Higher rates of disengagement among young adults attending a general adult community mental health team: Time to consider a youth-specific service? Early Interv Psychiatry 2020; 14:330-335. [PMID: 31368245 DOI: 10.1111/eip.12860] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 01/01/2019] [Accepted: 07/14/2019] [Indexed: 11/30/2022]
Abstract
AIM The initial onset of mental illness occurs most frequently in adolescence or early adulthood. In order to inform the development of mental health services tailored for youth, we sought to compare the characteristics of young (18-25 years old) and older (over 25 years old) adults following referral to a general adult community mental health team. METHODS All individuals referred to a Dublin-based community mental health team and offered an appointment between January 1 and December 31, 2016 were included in the study. Information in relation to engagement patterns, demographic characteristics and clinical characteristics was collected. RESULTS A total of 298 appointments were offered during the study period among which 94 (31.6%) were for young adults. Significant differences in demographic and clinical characteristics between the two age groups were evident. Young adults were significantly less likely to have been prescribed psychotropic medication at the point of referral (63% vs. 82% respectively, χ2 = 12.30, p < .001). Older adults were four times more likely to demonstrate a good level of early engagement in treatment than young adults (AOR 4.00, 95% CI 1.11-14.37, p = .03). CONCLUSIONS Young adults had distinct clinical needs and a lower level of engagement in the early stage of treatment compared with their older counterparts in this community team. Further research and stakeholder consultation is needed to more clearly identify the issues in relation to patient engagement. These insights will help to inform the development of youth-specific community mental health services.
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Affiliation(s)
- Eric Roche
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,Swords Community Adult Mental Health Service, Dublin, Ireland
| | | | | | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Paul Lyne
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,Swords Community Adult Mental Health Service, Dublin, Ireland
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208
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Pilon D, Szukis H, Singer D, Morrison L, Sheehan JJ, Lefebvre P. Use of home health and other healthcare delivery pathways among privately insured patients with and without treatment-resistant depression. Curr Med Res Opin 2020; 36:865-874. [PMID: 31985319 DOI: 10.1080/03007995.2020.1722081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To assess the real-world use of home health services (HHS) among patients with major depressive disorder (MDD) with and without treatment-resistant depression (TRD).Methods: Adults (18-64 years) from a commercial claims database (07/2009 to 03/2015) were categorized into three cohorts: "TRD"(N = 6411), "non-TRD MDD"(N = 33,068), "non-MDD"(N = 149,884) stratified based on use of HHS (HHS vs. no-HHS). Healthcare resource utilization (HRU) and costs were evaluated up to two years following the first antidepressant pharmacy claim using descriptive statistics. HRU (e.g. inpatient, outpatient, emergency department visits) and costs were measured per-patient-per-year (PPPY) in 2015 USD.Results: During the follow-up period, 18.0% of TRD, 12.4% of non-TRD MDD, and 6.5% of non-MDD patients received HHS. Mean all-cause healthcare costs PPPY were numerically higher among patients with HHS use. Among the TRD cohort, patients using HHS had healthcare costs of $40,040 PPPY while patients with TRD and no-HHS had healthcare costs of $12,272 PPPY. Within the non-TRD MDD cohort, HHS users incurred healthcare costs of $28,767 PPPY and non-HHS users incurred costs of $7227 PPPY. Patients without MDD who used HHS had annual healthcare costs of $22,340 while non-MDD patients who did not use HHS had healthcare costs of $3479 PPPY. However, among HHS users, HHS costs represented a relatively small proportion of total healthcare costs.Conclusions: The high proportion of TRD patients using HHS suggests it is a utilized healthcare delivery pathway by TRD patients.
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Affiliation(s)
| | - Holly Szukis
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - David Singer
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
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209
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Engagement in specialized early intervention services for psychosis as an interplay between personal agency and critical structures: A qualitative study. Int J Nurs Stud 2020; 108:103583. [PMID: 32502820 DOI: 10.1016/j.ijnurstu.2020.103583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Specialized early intervention programs for individuals experiencing a first episode of psychosis prioritize service engagement, generally operationalized as attendance, treatment completion, therapeutic alliance, and treatment adherence. However, there are critical theoretical and methodological gaps in understanding how service users experience and define their engagement with the service. OBJECTIVES This study aimed to explore how current and former service users define their engagement with a specialized early intervention program. DESIGN A qualitative descriptive approach was used to explore service users' decisions to use, remain involved with, and/or leave early intervention services. SETTING This study took place in an early intervention service for psychosis in Montreal, Canada. PARTICIPANTS Twenty-four participants who had experienced a first episode of psychosis and had been engaged in the service to varying degrees (fully engaged, partially engaged, disengaged) took part in in-depth interviews. METHODS In-depth interviews were employed to collect rich insights into participants' experiences and perceptions. The interviews were transcribed and analysed using thematic analysis, beginning with an inductive approach and completing the analysis using a theoretical approach. During the analysis, our original notions of engagement and disengagement were challenged by theorizing engagement in terms of agency and structure. Researchers engaged in reflexive practices to maintain and promote research rigor and trustworthiness. RESULTS Participants' narratives were thematically analyzed and organized into three themes: fluidity and temporality of engagement and disengagement; engagement as an ongoing negotiation; and critical structures and agency. Participants described engagement in a variety of ways, some of which were broader than service use and focused on self-care and commitment to recovery. These conceptions were subject to change as the individuals' perceptions of their needs changed. As needs changed, individuals also negotiated and renegotiated their care needs with themselves and with their treatment team. These exercises of agency were constrained by key structures: the treatment team, family and friends, and societal conceptions of mental health. CONCLUSIONS Our study findings argue for an expanded definition of engagement which prioritizes individuals' experience and acknowledges the steps towards recovery that they may make outside of the purview of the service. It also underlines the importance of a treatment structure which aligns with individuals' needs for both support and autonomy.
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Romanelli M, Lindsey MA. Patterns of Healthcare Discrimination Among Transgender Help-Seekers. Am J Prev Med 2020; 58:e123-e131. [PMID: 32001051 DOI: 10.1016/j.amepre.2019.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Affirmative health care is imperative to address health and mental health disparities faced by transgender communities. Yet, transgender help-seekers experience discrimination that precludes their access to and participation in care. This study uses latent class analysis to examine patterns of healthcare discrimination among transgender help-seekers. Predictors of class membership are investigated to identify subpopulations at highest risk for healthcare discrimination. METHODS Data were obtained from the 2015 U.S. Transgender Survey and analyzed in 2019. Ten healthcare experiences were included as latent class indicators. Latent class analysis and regression were performed in Mplus, version 8 to identify latent subgroups and examine the relationship between respondent characteristics and the latent classes. RESULTS The final sample included 23,541 respondents. A 3-class model fit best: Class 1 experienced overt discrimination and interfaced with providers with limited trans-competence; Class 2 did not experience healthcare discrimination or report issues related to providers' trans-competence; and Class 3 did not experience discrimination but had providers with low trans-competence. Transmen and respondents who were out as trans to their providers and reported psychological distress, suicidal thoughts, and disabilities were more likely to be members of Class 1 or 3 than Class 2. CONCLUSIONS Experiences of healthcare discrimination are not homogeneous across transgender help-seekers. Predictors of the latent classes indicated that transgender help-seekers holding an additional marginalized identity may be at higher risk for healthcare discrimination or care from providers with limited trans-competence. Targeted engagement and education interventions might improve these transgender help-seekers' access to and connections with care.
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Affiliation(s)
- Meghan Romanelli
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, New York.
| | - Michael A Lindsey
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, New York
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211
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Quinn A. Denial of Alcohol Treatment Need among Baby Boomers across Time: Implications for Social Work. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:174-188. [PMID: 32202232 DOI: 10.1080/01634372.2020.1744058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/14/2020] [Accepted: 03/14/2020] [Indexed: 06/10/2023]
Abstract
As baby boomers continue to enter older adulthood in the coming decades, research suggests that this cohort is expected to exhibit changes in alcohol usage and treatment need patterns compared to previous older-adult cohorts. The literature suggests that unmet alcohol treatment need may be related to denial of treatment need among baby boomers who possess a diagnosable alcohol-use disorder (AUD). Therefore, this study explores potential risk and protective factors predicting alcohol-use among baby boomers who d\eny treatment need at two time periods. Data was obtained from the National Survey of Drug and Health (NSDUH). Variable selection procedures were performed at each time period, resulting in two predictive models for baby boomers who denied alcohol treatment need when treatment was indicated by a concurrent diagnosable alcohol-use disorder. The primary findings suggest that generalized, nonspecific alcohol treatment may be ineffective for treating AUD baby boomers who deny alcohol treatment need. Rather, as baby boomers continue to enter older adulthood, individualized specialty treatments may be needed in order to provide effective alcohol treatment for this unprecedentedly large birth cohort.
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Affiliation(s)
- Adam Quinn
- Barbara Solomon School Of Social Work, Walden University, Minneapolis, Minnesota, USA
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212
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Papamalis FE, Kalyva E, Teare MD, Meier PS. The role of personality functioning in drug misuse treatment engagement. Addiction 2020; 115:726-739. [PMID: 31779050 DOI: 10.1111/add.14872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/11/2019] [Accepted: 10/23/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM Personality functioning is predictive of drug misuse and relapse, yet little is known about the role of personality in engagement with the treatment process. This study aimed to estimate the extent to which broad- and facet-level characteristic adaptations contribute to or hinder treatment engagement, while controlling for psychosocial indicators. DESIGN Multi-site cross-sectional survey. SETTING In-patient treatment units covering 80% of residential treatment entries in Greece. PARTICIPANTS A total of 338 service users, 287 (84.9%) male, 51 (15.1%) female, average age 33.4 years. MEASUREMENTS Expressions of personality functioning (characteristic adaptations) were assessed using the Severity Indices of Personality Problems (SIPP-118). Treatment engagement was measured using the Client Evaluation of Self and Treatment, in-patient version (CEST). FINDINGS Dysfunctional levels of relational capacities predicted counselling rapport [β = 1.50, 95% confidence interval (CI) = 0.326-2.69, P = 0.013], treatment participation (β = 2.09, 95% CI = 1.15-3.11, P < 0.001) and treatment satisfaction (β = 1.65, 95% CI = 0.735-2.57, P < 0.001). Counselling rapport was also predicted by dysfunctional levels in self-control (β = 1.78, 95% CI = 0.899-2.67, P < 0.001), self-reflective functioning at the facet-level (β = 2.24, 95% CI = 1.01-3.46, P < 0.001) and aggression regulation (β = 1.43, 95% CI = 0.438-2.42, P = 0.005). Dysfunctional levels on social concordance (β = -1.90, 95% CI = -2.87 to -0.941, P = 0.001), emotional regulation (β = 1.90, 95% CI = 0.87-2.92, P < 0.001) and intimacy (β = 2.04, 95% CI = 1.31-3.05, P < 0.001) were significant predictors of treatment participation. Treatment readiness and desire for help predicted treatment engagement. CONCLUSIONS In people attending substance use treatment services, maladaptive interpersonal patterns and relational intimacy, emotional dysregulation and impulse control may be associated with low levels of counselling rapport and treatment participation. Low frustration tolerance and aggressive impulses also appeared to predict low participation.
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Affiliation(s)
| | - Efrosini Kalyva
- Child and Adolescent Research and Development Centre, Thessaloniki, Greece
| | - M Dawn Teare
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Petra S Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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213
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Smith M, Francq B, McConnachie A, Wetherall K, Pelosi A, Morrison J. Clinical judgement, case complexity and symptom scores as predictors of outcome in depression: an exploratory analysis. BMC Psychiatry 2020; 20:125. [PMID: 32183799 PMCID: PMC7076946 DOI: 10.1186/s12888-020-02532-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/04/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Clinical guidelines for depression in adults recommend the use of outcome measures and stepped care models in routine care. Such measures are based on symptom severity, but response to treatment is likely to also be influenced by personal and contextual factors. This observational study of a routine clinical sample sought to examine the extent to which "symptom severity measures" and "complexity measures" assess different aspects of patient experience, and how they might relate to clinical outcomes, including disengagement from treatment. METHODS Subjects with symptoms of depression (with or without comorbid anxiety) were recruited from people referred to an established Primary Care Mental Health Team using a stepped care model. Each participant completed three baseline symptom measures (the Personal Health Questionnaire (PHQ), Generalised Anxiety Disorder questionnaire (GAD) and Clinical Outcomes in Routine Evaluation (CORE-10)), and two assessments of "case complexity" (the Minnesota-Edinburgh Complexity Assessment Measure (MECAM) and a local complexity assessment). Clinician perception of likely completion of treatment and patient recovery was also assessed. Outcome measures were drop out and clinical improvement on the PHQ. RESULTS 298 subjects were recruited to the study, of whom 258 had a sufficient dataset available for analysis. Data showed that the three measures of symptom severity used in this study (PHQ, GAD and CORE-10) seemed to be measuring distinct characteristics from those associated with the measures of case complexity (MECAM, previous and current problem count). Higher symptom severity scores were correlated with improved outcomes at the end of treatment, but there was no association between outcome and complexity measures. Clinicians could predict participant drop-out from care with some accuracy, but had no ability to predict outcome from treatment. CONCLUSIONS These results highlight the extent to which drop-out complicates recovery from depression with or without anxiety in real-world settings, and the need to consider other factors beyond symptom severity in planning care. The findings are discussed in relation to a growing body of literature investigating prognostic indicators in the context of models of collaborative care for depression.
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Affiliation(s)
- M. Smith
- grid.413301.40000 0001 0523 9342NHS Greater Glasgow and Clyde, Glasgow, UK
| | - B. Francq
- grid.7942.80000 0001 2294 713XInstitute of Statistics, Biostatistics and Actuarial Sciences, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - A. McConnachie
- grid.8756.c0000 0001 2193 314XRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - K. Wetherall
- grid.8756.c0000 0001 2193 314XRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - J. Morrison
- grid.8756.c0000 0001 2193 314XSenate Office, University of Glasgow, Glasgow, UK
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Abstract
Posttraumatic stress disorder (PTSD) treatments primarily address traumatic memories, despite PTSD's association with both traumatic and positive memory difficulties. Addressing this gap, we explored the perspectives of trauma-exposed individuals with mental health treatment experience on therapeutically addressing positive memories. A treatment-seeking sample from a community mental health center (n1 = 60) and a community sample from Amazon's Mechanical Turk (n2 = 123) were queried on the acceptability, feasibility, and delivery/components of a pilot positive memory technique. Results indicated interest or willingness in therapeutically discussing positive memories; most endorsed benefits were improved mood, positive thoughts, and self-esteem. Few barriers were identified (e.g., lack of evidence) compared with feasibility factors (ease/usefulness, improved satisfaction/tolerability, and engagement in PTSD treatment). Preferred treatment components included identifying/discussing positive memories, eliciting associated positive affect, and writing about the positive memory as homework. Results provide formative support for the development and integration of a positive memory technique into PTSD treatments.
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215
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Hayes C, Simmons M, Palmer VJ, Hamilton B, Simons C, Hopwood M. Experiences of an adolescent inpatient model of care: Adolescent and caregiver perspectives. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:109-124. [PMID: 32068327 DOI: 10.1111/jcap.12266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/23/2019] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
Abstract
PROBLEM Adolescent inpatient units have been studied regarding their effectiveness, yet little is known about the experiences of young people who are admitted and their caregivers. It is important to address this gap to understand adolescent inpatient models of care and therapeutic outcomes to maximize the benefit. Our aim was to explore adolescent and caregivers' experiences of an inpatient model of care (MoC) and perceived helpfulness. METHODS A longitudinal prospective qualitative design was utilized. Semistructured interviews were conducted with 16 adolescents and 12 caregivers at T1 (admission), T2 (discharge), and T3 (6 months postdischarge). Data were analysed first thematically and then using trajectory analysis. Themes from the three time-points are presented from the combined perspectives of adolescents and caregivers. FINDINGS Experiences described followed a recovery narrative consisting of three key phases which included, "waiting for help" (T1), "help arrived" (T2), and having "returned to regular life" (T3). The overarching trajectory theme was a "winding road to recovery." CONCLUSION Findings provide insights into the lived experiences from adolescents who have had an inpatient stay and their caregivers of an adolescent-specific inpatient MoC. These findings can help conceptualize quality adolescent models of care for young people and their families.
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Affiliation(s)
- Claire Hayes
- Department of Psychiatry, The Albert Road Clinic and The University of Melbourne, Melbourne, Victoria, Australia
| | - Magenta Simmons
- The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria J Palmer
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bridget Hamilton
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christine Simons
- Department of Psychiatry, The Albert Road Clinic and The University of Melbourne, Melbourne, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, The Albert Road Clinic and The University of Melbourne, Melbourne, Victoria, Australia
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216
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Bamgbade BA, Barner JC, Ford KH, Brown CM, Lawson WB, Burdine K. Willingness to Seek Help for Depression in Young African American Adults: Study Protocol. JMIR Res Protoc 2020; 9:e16267. [PMID: 32044756 PMCID: PMC7055854 DOI: 10.2196/16267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/26/2022] Open
Abstract
Background In the United States, among those living with mental illness, 81% of African American (AA) young adults do not seek treatment compared with 66% of their white counterparts. Although the literature has identified unique culturally related factors that impact help seeking among AAs, limited information exists regarding the development and evaluation of interventions that incorporate these unique factors. Objective This study aims to describe a study protocol designed to develop a culturally relevant, theory-based, psychoeducational intervention for AA young adults; to determine if exposure to the intervention impacts AA young adults’ willingness to seek help; and to determine whether cultural factors and stigma add to the prediction of willingness to seek help. Methods The Theory of Planned Behavior (TPB) and Barrera and Castro’s framework for cultural adaptation of interventions were used as guiding frameworks. In stage 1 (information gathering), a literature review and three focus groups were conducted to identify salient cultural beliefs. Using stage 1 results, the intervention was designed in stage 2 (preliminary adaptation design), and in stage 3 (preliminary adaptation tests), the intervention was tested using pretest, posttest, and 3-month follow-up surveys. An experimental, mixed methods, prospective one-group intervention design was employed, and the primary outcomes were participants’ willingness and intention to seek help for depression and actual help-seeking behavior. Results This study was funded in May 2016 and approved by the University of Texas at Austin institutional review board. Data were collected from November 2016 to March 2016. Of the 103 students who signed up to participate in the study, 70 (67.9%) completed the pre- and posttest surveys. The findings are expected to be submitted for publication in 2020. Conclusions The findings from this research are expected to improve clinical practice by providing empirical evidence as to whether a culturally relevant psychoeducational intervention is useful for improving help seeking among young AAs. It will also inform future research and intervention development involving the TPB and willingness to seek help by identifying the important factors related to willingness to seek help. Advancing this field of research may facilitate improvements in help-seeking behavior among AA young people and reduce the associated mental health disparities that apparently manifest early on. International Registered Report Identifier (IRRID) DERR1-10.2196/16267
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Affiliation(s)
- Benita A Bamgbade
- Department of Pharmacy and Health Systems Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Jamie C Barner
- Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Kentya H Ford
- Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Carolyn M Brown
- Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - William B Lawson
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Kimberly Burdine
- Student Counseling Center, The University of Texas at Dallas, Dallas, TX, United States
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217
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Fisher E, Wood SJ, Upthegrove R, Aldred S. Designing a feasible exercise intervention in first-episode psychosis: Exercise quality, engagement and effect. Psychiatry Res 2020; 286:112840. [PMID: 32062521 DOI: 10.1016/j.psychres.2020.112840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 02/04/2023]
Abstract
First-episode psychosis (FEP) is the first presentation of a psychotic disorder that usually propagates during early adulthood. FEP represents an important early intervention point to attenuate the metabolic risks associated with psychosis and its treatment. Exercise has potential to improve metabolic and functional outcome, but engaging this population in regular exercise is typically difficult. Promoting enjoyment and attendance may improve participation. 22 men with FEP were randomised to a 12-week intervention of exercise training, or treatment as usual. Exercise was pre-standardised based on measures of heart rate to assess intensity. Symptoms of psychosis were assessed, alongside measures of quality of life, disability and habitual activity. The study observed 83% attendance at exercise sessions, with target intensity attained. There were clinically meaningful decreases in PANSS positive (17.31%) and general psychopathology (10.98%) scores and exercise was protective of negative score increase observed in the control group (13.89%). Assessment of disability declined after training (12.65%) compared with a 20.78% increase in controls. This study demonstrated that engagement of FEP patients in an intervention of high quality exercise was possible. Positive changes in psychopathology scores and disability show that the benefits of regular exercise are achievable with a potential positive impact on clinical presentation.
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Affiliation(s)
- Emily Fisher
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, U.K
| | - Stephen J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Melbourne VIC 3052, Australia; School of Psychology, University of Birmingham, Edgbaston, B15 2TT, U.K.; Centre for Youth Mental Health, University of Melbourne, VIC 3010, Australia
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Edgbaston, B15 2TT, U.K.; Department of Psychiatry, University of Birmingham, Edgbaston, B15 2TT, U.K
| | - Sarah Aldred
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, U.K.; Institute for Mental Health, University of Birmingham, Edgbaston, B15 2TT, U.K..
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218
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Tsai J, Huang M, Wilkinson ST, Edelen C. Effects of video psychoeducation on perceptions and knowledge about electroconvulsive therapy. Psychiatry Res 2020; 286:112844. [PMID: 32192999 DOI: 10.1016/j.psychres.2020.112844] [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: 06/15/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 11/21/2022]
Abstract
This study examined the effects of video psychoeducation about electroconvulsive therapy (ECT) on perceptions and knowledge about ECT. A pre-post design was used with a national sample of 1,068 adults who screened positive for depression. Participants' perceptions and knowledge about ECT were assessed before and after watching a psychoeducational video about ECT. Participants showed significant increases in positive perceptions and accurate knowledge about ECT after watching the psychoeducational video. In the perception domain, the items "ECT can be lifesaving" and "fears that ECT can be painful" showed the largest positive increases. In the knowledge domain, items related to "ECT is one of the safest procedures performed" and "ECT can be given safely to older persons" showed the largest increases. Over 20% of participants changed their mind and reported they were willing to try ECT after watching the video. Together, these findings suggest video psychoeducation about ECT holds great potential to improve perceptions and knowledge about ECT, particularly as new technologies are developed to create, distribute, and host videos to reach large audiences.
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Affiliation(s)
- Jack Tsai
- U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, West Haven, CT USA; U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven, CT USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA.
| | - Minda Huang
- Department of Psychology, University of Hartford, West Hartford, CT USA
| | - Samuel T Wilkinson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Carl Edelen
- U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven, CT USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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219
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Bell IH, Rossell SL, Farhall J, Hayward M, Lim MH, Fielding-Smith SF, Thomas N. Pilot randomised controlled trial of a brief coping-focused intervention for hearing voices blended with smartphone-based ecological momentary assessment and intervention (SAVVy): Feasibility, acceptability and preliminary clinical outcomes. Schizophr Res 2020; 216:479-487. [PMID: 31812327 DOI: 10.1016/j.schres.2019.10.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 06/25/2019] [Accepted: 10/10/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Voice-hearing experiences can be distressing and impairing, and existing psychological treatments show modest effectiveness. Ecological momentary assessment and intervention (EMA/I) are two promising approaches which may be used as digital tools to support and enhance existing psychological therapies. The aim of this study was to investigate the potential clinical utility of smartphone-based EMA/I in a blended, coping focused therapy for voice-hearing experiences. METHOD This pilot RCT focused on feasibility, acceptability and preliminary estimations of efficacy. Thirty-four participants with persisting and distressing voices were randomised to receive the four-session intervention along-side treatment-as-usual (TAU) or TAU-only. RESULTS Findings supported the feasibility and acceptability of the approach, with good engagement and satisfaction rates, and clinical outcomes showed the intervention holds promise for improving coping, overall severity of voices and to some degree their negative impact. CONCLUSION This is the first examination of the use of EMA/I in a blended therapy for psychotic experiences, with findings suggesting these technologies show promise as clinical tools.
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Affiliation(s)
- Imogen H Bell
- Centre for Mental Health, Swinburne University of Technology, Australia.
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Australia; Department of Psychiatry, St. Vincent's Hospital, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Australia; NorthWestern Mental Health, Melbourne Health, Australia
| | - Mark Hayward
- Sussex Partnership NHS Foundation Trust, UK; School of Psychology, University of Sussex, UK
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Australia
| | - Sarah F Fielding-Smith
- Sussex Partnership NHS Foundation Trust, UK; School of Psychology, University of Sussex, UK
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Australia.
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220
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Harrison I, Trevethan CT, Pasciak F, Irwin A. Part and Parcel: A Qualitative Interview Study Examining the Experience of Client Rudeness by Mental Health Workers. Issues Ment Health Nurs 2020; 41:122-131. [PMID: 31603711 DOI: 10.1080/01612840.2019.1644567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Considerable research has demonstrated that workplace rudeness can have a variety of negative consequences. However, although research has examined the impact of patient aggression, no research has examined patient or client rudeness towards those who work in mental health roles. The present study investigated the nature of client rudeness, how mental health workers respond and the coping strategies used. Eighteen participants from a range of mental health roles and experience levels participated in semi-structured interviews based on their experience of client rudeness. Thematic analysis revealed that participants experienced a variety of client behaviours they classified as rude, the majority of which were verbal. Reasons for rudeness included the client's personal history, mood, and mental health, and as such rudeness was conceptualised as simply a part of the job. Client rudeness was found to have both negative and positive outcomes on a range of areas including work and client relationships. Participants identified supervisors and colleagues as key sources of support for coping with rudeness. These findings suggest that rudeness is "part and parcel" of a mental health practitioner's role. Supervisor support and further training are recommended to help practitioners deal with rudeness in practice.
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Affiliation(s)
- Isabelle Harrison
- School of Psychology, Applied Psychology and Human Factors group, University of Aberdeen, Aberdeen, UK
| | - Ceri T Trevethan
- School of Psychology, Applied Psychology and Human Factors group, University of Aberdeen, Aberdeen, UK.,Department of Clinical Neuropsychology, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK.,Aberdeenshire Clinical Psychology, Crichiebank Business Centre, Inverurie, UK
| | - Flawia Pasciak
- School of Psychology, Applied Psychology and Human Factors group, University of Aberdeen, Aberdeen, UK
| | - Amy Irwin
- School of Psychology, Applied Psychology and Human Factors group, University of Aberdeen, Aberdeen, UK
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221
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Muroff J, Robinson W. Tools of Engagement: Practical Considerations for Utilizing Technology-Based Tools in CBT Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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222
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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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223
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Patient experience of Guided self-help CBT intervention for VoicEs (GiVE) delivered within a pilot randomized controlled trial. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Access to cognitive behaviour therapy for those with psychosis (CBTp) remains poor. The most frequently endorsed barrier to implementation is a lack of resources. To improve access to CBTp, we developed a brief form of CBTp that specifically targets voice-related distress. The results of our pilot trial of guided self-help CBT for voices (GiVE) suggest that the therapy is both acceptable and beneficial. The present study aims to explore the subjective patient experience of accessing GiVE in the context of a trial. We interviewed nine trial participants using the Change Interview and a mixed methods approach. Most participants reported at least one positive change that they attributed to GiVE. We extracted five themes: (1) changes that I have noticed; (2) I am not alone; (3) positive therapy experiences; (4) I want more therapy; and (5) helping myself. The themes indicate that participating in the GiVE trial was generally a positive experience. The main areas in which participants experienced changes were improved self-esteem, and the ability to cope with voices. Positive changes were facilitated by embracing and enacting ‘self-help’ and having support both in and out of the therapy sessions. The findings support the use of self-help materials with those distressed by hearing voices, but that support both within and outside the clinical setting can aid engagement and outcomes. Overall, the findings support the continued investigation of GiVE.
Key learning aims
(1)
To explore participants’ experience of accessing GiVE as part of a trial.
(2)
To identify what (if any) changes participants noticed over the course of the GiVE trial.
(3)
To identify what participants attribute these changes to.
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224
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Lynch DA, Medalia A, Saperstein A. The Design, Implementation, and Acceptability of a Telehealth Comprehensive Recovery Service for People With Complex Psychosis Living in NYC During the COVID-19 Crisis. Front Psychiatry 2020; 11:581149. [PMID: 33101093 PMCID: PMC7506069 DOI: 10.3389/fpsyt.2020.581149] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The COVID-19 crisis and subsequent stay-at-home orders have produced unprecedented challenges to the dissemination of recovery oriented behavioral health services (RS) that support the treatment of those with complex psychosis (CP).This population has typically been managed with in-person pharmacotherapy and/or RS, with the goals of relieving symptoms, improving life satisfaction and increasing community engagement. COVID-19 related social distancing measures have required rapid shifts in care management, while easing of telehealth regulations has allowed for flexibility to approach RS differently. It is essential to learn from the RS telemedicine implementation experience, so that RSs can maintain care for this vulnerable and needy population. METHOD This paper describes the successful telehealth conversion of a NYC-based, university affiliated RS that serves adults with severe mental illnesses (SMI; n = 64). Results focus on the telehealth acceptance rates of the subset of participants with CP (n = 23). RESULTS The RS continued providing services including intake, care coordination, group psychotherapies, skills training groups, individual skills coaching, and vocational/educational supports. The telehealth conversion rates of the CP subsample indicated that 90% of CP patients accepted telehealth sessions and maintained their specific treatment plans in the virtual format. Mean comparisons between session attendance and cancellations/no-shows during the six-week period before and after telehealth conversion showed no significant differences in service utilization. DISCUSSION RSs play an essential role in the treatment of CP and telehealth may prove to be a viable format of care delivery even after the COVID-19 crisis subsides. The multiple factors in the inner and outer treatment setting that contributed to successful conversion to telehealth will be considered along with the challenges that clinicians and patients encountered.
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Affiliation(s)
- David A Lynch
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, United States
| | - Alice Medalia
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, United States
| | - Alice Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
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225
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Thomas EC, Snethen G, O'Shea A, Suarez J, Hurford I, Salzer MS. An Examination of the Community Participation Interests of Young Adults with Serious Mental Illnesses. J Behav Health Serv Res 2019; 47:526-543. [PMID: 31875282 DOI: 10.1007/s11414-019-09678-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Participation in various aspects of community life (e.g., education, employment) plays a critical role in fostering young adult development and health. To support behavioral health services in addressing a broader array of meaningful community participation areas, the current study examined the participation interests of young adults with serious mental illnesses via a literature review and focus groups interviews. Literature review results revealed a range of community participation areas of interest to these individuals, including employment, education, religion and spirituality, social networking (e.g., using social media), volunteering activities, socializing, and civic and artistic participation (e.g., attending a political event, playing music). Focus group participants named many of these same areas, but also mentioned unique areas of participation that have not been the focus of previous research (i.e., playing games, sports, exploration of other communities (e.g., traveling), hanging out, and nature-based participation). Implications for future research and behavioral health practice are discussed.
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Affiliation(s)
- Elizabeth C Thomas
- College of Public Health, Temple University, Philadelphia, USA.
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1700 N Broad St, Philadelphia, PA, 19121, USA.
| | | | - Amber O'Shea
- College of Education, Pennsylvania State University University Park, State College, PA, USA
| | - John Suarez
- College of Public Health, Temple University, Philadelphia, USA
| | - Irene Hurford
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Mark S Salzer
- College of Public Health, Temple University, Philadelphia, USA
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226
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Abstract
A prior meta-analysis found that the World Health Organization Brief Intervention and Contact Program (WHO BIC) significantly reduces suicide risk. WHO BIC has not been studied in high-income countries. We piloted an adapted version of WHO BIC on an inpatient mental health unit in the United States. We assessed the feasibility and acceptability. We also evaluated changes in suicidal ideation, hopelessness, and connectedness using a repeated measures analysis of variance. Of 13 eligible patients, 9 patients enrolled. Patients experienced significant improvements in suicidal ideation, hopelessness, and connectedness at 1 and 3 months (Beck Scale for Suicidal Ideation, F(2,16) = 14.96, p < 0.01; Beck Hopelessness Scale, F(2,16) = 5.88, p < 0.05; perceived burdensomeness subscale, F(2,16) = 10.97, p < 0.013; and thwarted belongingness subscale, F(2,16) = 4.77, p < 0.03). Patients were highly satisfied. An adapted version of WHO BIC may be feasible to implement in a high-resource setting, but trials need to confirm efficacy.
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227
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Lewis SP, Hasking P. Putting the "Self" in Self-Injury Research: Inclusion of People With Lived Experience in the Research Process. Psychiatr Serv 2019; 70:1058-1060. [PMID: 31337319 DOI: 10.1176/appi.ps.201800488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Worldwide, nonsuicidal self-injury has emerged as a paramount concern given its associations with psychiatric difficulties and suicide risk. Despite many gains in the understanding of self-injury, there remain numerous unanswered questions in the field, including how to enhance both treatment and service provision. With this in mind, this Open Forum represents a call to action, advocating and providing strategies for inclusion of people with lived experience in self-injury research. An inclusive approach to self-injury research can yield greater understanding about how to best serve the needs of those who self-injure and others who are affected by self-injury.
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Affiliation(s)
- Stephen P Lewis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada (Lewis); Department of Psychology, Curtin University, Perth, Western Australia, Australia (Hasking)
| | - Penelope Hasking
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada (Lewis); Department of Psychology, Curtin University, Perth, Western Australia, Australia (Hasking)
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228
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Myers B, Johnson K, Lucas W, Govender R, Manderscheid R, Williams PP, Koch JR. South African service users' perceptions of patient-reported outcome and experience measures for adolescent substance use treatment: A qualitative study. Drug Alcohol Rev 2019; 38:823-830. [PMID: 31659815 DOI: 10.1111/dar.12996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/19/2019] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS Patient-reported outcome measures (PROM) and experience measures (PREM) for substance use disorder (SUD) treatment exist for adults but have unknown relevance for adolescents. This study aimed to explore adolescents' perceptions of effective SUD treatment and possible barriers to completing PROMs and PREMs to guide efforts to adapt the South African Addiction Treatment Services Assessment (SAATSA) for adolescents. DESIGN AND METHODS Five focus groups were conducted with 38 adolescent service users recruited from residential and outpatient SUD treatment facilities in South Africa. Group discussions explored perceptions of treatment components necessary for desired SUD treatment outcomes, treatment experiences that support engagement in care, and perceptions of PROM and PREM completion. RESULTS Participants viewed treatment elements that enhance motivation for change, coping and emotional regulation; provide recreational alternatives to substance use; and improve family relationships and home environments as critical to positive treatment outcomes. They reflected that provider characteristics and developmentally and culturally appropriate services facilitated engagement in treatment. PROM and PREM completion seemed acceptable, with participants suggesting ways to enhance their appeal. DISCUSSION AND CONCLUSION Findings confirm that adult-oriented PROMs and PREMs require adaptation for adolescents. Service user inputs identified ways to expand the content of the SAATSA to better reflect adolescents' treatment priorities. These inputs have also guided changes to item formulation and administration procedures to enhance the SAATSA's acceptability for adolescents. Ensuring the SAATSA addresses treatment outcomes and experiences that matter to adolescents is vital for generating information to guide improvements to adolescent SUD services.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Warren Lucas
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Rajen Govender
- Department of Sociology, University of Cape Town, Cape Town, South Africa.,Violence Injury and Peace Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ron Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington, USA
| | - Petal Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
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229
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Green R, Mitchell PF, Lee K, Svensson E, Toh JW, Barentsen C, Copeland M, Newton JR, Hawke KC, Brophy L. Key features of an innovative sub-acute residential service for young people experiencing mental ill health. BMC Psychiatry 2019; 19:311. [PMID: 31646990 PMCID: PMC6813091 DOI: 10.1186/s12888-019-2303-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies across international settings have highlighted a need to improve the appropriateness and continuity of services for young people experiencing mental ill health. This paper examines key features of a sub-acute youth mental health residential service model, Youth Prevention and Recovery Care (Y-PARC) service. Y-PARC provides up to 4 weeks care to 16 to 25 year-olds at risk of hospitalisation and to those transitioning out of hospital inpatient units. The research was conducted at one of three Y-PARCs located in Victoria, Australia. METHODS This paper presents findings from analysis of two data sources collected during evaluation of a Y-PARC service in 2015-17. Routinely collected administrative data of Y-PARC residents (n = 288) were analysed and semi-structured interviews were conducted with 38 participants: a) former residents (n = 14); b) family members of group a) (n = 5); key stakeholders (n = 9); and, Y-PARC staff (n = 10 respondents in 3 group interviews). Analysis of the qualitative data was thematic and structured by the interview guide, which covered the key service aims. RESULTS Consistent with the aims of the service, respondents described practice at Y-PARC that aligns with recovery-oriented care. Key features emphasised were: a safe and welcoming environment for residents and families; provision of person-centred care; promotion of autonomy and self-help; informal interactions with staff allowing for formation of naturalistic relationships; time spent with other young people with similar experiences; and, assurance upon exit that the 'door is always open.' High levels of satisfaction were reported. Outcomes described included: improved resilience; better understanding of mental health; the importance of seeking help; and, stronger connections to therapeutic services. Longer and multiple stays were associated with progressive and sustained change. Family members and stakeholders widely reported that the service fills a gap between community services and acute inpatient mental health hospital wards. Some challenging areas of practice identified included: integration of evidence-based psychosocial interventions; provision of care within a model that blends clinical and psychosocial support services; and, negotiation of family-inclusive practice. CONCLUSIONS The Y-PARC service model shows promise with young people experiencing mental ill health, particularly in improving the range and availability of options across a spectrum of need.
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Affiliation(s)
- Rachael Green
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
| | - Penelope Fay Mitchell
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
| | - Kira Lee
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
| | - Ella Svensson
- Orygen, the National Centre of Excellence in Youth Mental Health, 35 Poplar Roadd, Parkville, Victoria 3052 Australia
| | - Jia-Wern Toh
- Orygen, the National Centre of Excellence in Youth Mental Health, 35 Poplar Roadd, Parkville, Victoria 3052 Australia
| | - Carolyn Barentsen
- Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199 Australia
| | - Michala Copeland
- Mind Australia, 86-92 Mount Street, Heidelberg, Victoria 3084 Australia
| | - J. Richard Newton
- Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199 Australia
| | | | - Lisa Brophy
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
- Mind Australia, 86-92 Mount Street, Heidelberg, Victoria 3084 Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria Australia
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230
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Galvin HK, Petersen C, Subbian V, Solomonides A. Patients as Agents in Behavioral Health Research and Service Provision: Recommendations to Support the Learning Health System. Appl Clin Inform 2019; 10:841-848. [PMID: 31694055 PMCID: PMC6834452 DOI: 10.1055/s-0039-1700536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/28/2019] [Indexed: 12/29/2022] Open
Abstract
Authentic inclusion and engagement of behavioral health patients in their care delivery and in the process of scientific discovery are often challenged in the health care system. Consequently, there is a growing need to engage with and better serve the needs of behavioral health patients, particularly by leveraging health information technologies. In this work, we present rationale and strategies for improving patient engagement in this population in research and clinical care. First, we describe the potential for creating meaningful patient-investigator partnerships in behavioral health research to allow for cocreation of knowledge with patients. Second, in the context of behavioral health services, we explore the utility of sharing clinical notes to promote patients' agency in care delivery. Both lines of inquiry are centered in a Learning Health System model for behavioral health, where patients are agents in enhancing the therapeutic alliance and advancing the process of knowledge generation. Recommendations include genuinely democratizing the health care system and biomedical research enterprise through patient-centered information technologies such as patient portals. In research and technology development, we recommend seeking and tailoring behavioral health patients' involvement to their abilities, promoting patient input in data analysis plans, evaluating research and informatics initiatives for patients and clinicians, and sharing success and research findings with patients. In clinical practice, we recommend encouraging patients to read behavioral health notes on portals, engaging in proactive communication regarding note content, assessing outcomes including stress and anxiety in response to note content, and working with technology providers to support note-sharing governance and deployment.
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Affiliation(s)
| | - Carolyn Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Vignesh Subbian
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, United States
| | - Anthony Solomonides
- Department of Systems and Industrial Engineering, University of Arizona, Tucson, Arizona, United States
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231
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Dugdale S, Elison-Davies S, Semper H, Ward J, Davies G. Are Computer-Based Treatment Programs Effective at Reducing Symptoms of Substance Misuse and Mental Health Difficulties Within Adults? A Systematic Review. J Dual Diagn 2019; 15:291-311. [PMID: 31476983 DOI: 10.1080/15504263.2019.1652381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Comorbid substance misuse and mental health difficulties are recognized as a leading contributor to disease burden worldwide. Amid cuts to health care services, computer-based interventions may provide support for patients experiencing these difficulties. The aims of this systematic review were to identify and investigate the efficacy of these computer-based interventions at improving substance misuse and mental health outcomes.Methods: A systematic search was conducted of CINAHL Plus, PsycARTICLES, PsycINFO, Medline, Web of Science, and the Cochrane Library. Gray literature was also searched for relevant papers. Data were extracted from 33 papers, which met eligibility criteria by reporting a computer-based intervention designed to treat substance misuse and mental health in adults. Quality assessments were conducted on these papers.Results: Computer-based interventions generally led to an improvement of substance misuse and mental health outcomes within groups and when compared against waitlist control and psychoeducation. Computer-based interventions were effective at improving dual diagnosis outcomes, and improvements to mental health outcomes specifically were maintained for up to nine months. However, the combined effect of computer-based interventions and therapist support was found to be more effective than the effects of computer-based interventions alone.Conclusions: Many papers were limited by high attrition rates commonly attributed to "digital" interventions. Future research should consider systematically recruiting a range of participants, including those potentially affected by the digital divide, and incorporating methods within research to maintain engagement. This review was also limited by the heterogeneity of the papers reported, many of which differed between targeting dual diagnosis and targeting either substance misuse or mental health respectively, with outcomes investigating other difficulties out of curiosity.
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Affiliation(s)
| | | | | | | | - Glyn Davies
- Breaking Free Group, Manchester, United Kingdom
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232
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Jackson CA, Fleetwood K, Kerssens J, Smith DJ, Mercer S, Wild SH. Incidence of Type 2 Diabetes in People With a History of Hospitalization for Major Mental Illness in Scotland, 2001-2015: A Retrospective Cohort Study. Diabetes Care 2019; 42:1879-1885. [PMID: 31471379 DOI: 10.2337/dc18-2152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 04/25/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the incidence of type 2 diabetes in people with a history of hospitalization for major mental illness versus no mental illness in Scotland by time period and sociodemographics. RESEARCH DESIGN AND METHODS We used national Scottish population-based records to create cohorts with a hospital record of schizophrenia, bipolar disorder, or depression or no mental illness and to ascertain diabetes incidence. We used quasi-Poisson regression models including age, sex, time period, and area-based deprivation to estimate incidence and relative risks (RRs) of diabetes by mental illness status. Estimates are illustrated for people aged 60 years and in the middle deprivation quintile in 2015. RESULTS We identified 254,136 diabetes cases during 2001-2015. Diabetes incidence in 2015 was 1.5- to 2.5-fold higher in people with versus without a major mental disorder, with the gap having slightly increased over time. RRs of diabetes incidence were greater among women than men for schizophrenia (RR 2.40 [95% CI 2.01, 2.85] and 1.63 [1.38, 1.94]), respectively) and depression (RR 2.10 [1.86, 2.36] and 1.62 [1.43, 1.82]) but similar for bipolar disorder (RR 1.65 [1.35, 2.02] and 1.50 [1.22, 1.84]). Absolute and relative differences in diabetes incidence associated with mental illness increased with increasing deprivation. CONCLUSIONS Disparities in diabetes incidence between people with and without major mental illness appear to be widening. Major mental illness has a greater effect on diabetes risk in women and people living in more deprived areas, which has implications for intervention strategies to reduce diabetes risk in this vulnerable population.
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Affiliation(s)
- Caroline A Jackson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K.
| | - Kelly Fleetwood
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Jan Kerssens
- Information Services Division, National Services Scotland, NHS Scotland, Edinburgh, U.K
| | - Daniel J Smith
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, U.K
| | - Stewart Mercer
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K.,Institute of Health & Wellbeing, University of Glasgow, Glasgow, U.K
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
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Becker TD, Ho-Foster AR, Poku OB, Marobela S, Mehta H, Cao DTX, Yang LS, Blank LI, Dipatane VI, Moeng LR, Molebatsi K, Eisenberg MM, Barg FK, Blank MB, Opondo PR, Yang LH. "It's When the Trees Blossom": Explanatory Beliefs, Stigma, and Mental Illness in the Context of HIV in Botswana. QUALITATIVE HEALTH RESEARCH 2019; 29:1566-1580. [PMID: 30739566 PMCID: PMC7577021 DOI: 10.1177/1049732319827523] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Mental illness is a common comorbidity of HIV and complicates treatment. In Botswana, stigma impedes treatment of mental illness. We examined explanatory beliefs about mental illness, stigma, and interactions between HIV and mental illness among 42 adults, from HIV clinic and community settings, via thematic analysis of interviews. Respondents endorse witchcraft as a predominant causal belief, in addition to drug abuse and effects of HIV. Respondents describe mental illness as occurring "when the trees blossom," underscoring a conceptualization of it as seasonal, chronic, and often incurable and as worse than HIV. Consequently, people experiencing mental illness (PEMI) are stereotyped as dangerous, untrustworthy, and cognitively impaired and discriminated against in the workplace, relationships, and sexually, increasing vulnerability to HIV. Clinical services that address local beliefs and unique vulnerabilities of PEMI to HIV, integration with peer support and traditional healers, and rehabilitation may best address the syndemic by facilitating culturally consistent recovery-oriented care.
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Affiliation(s)
| | - Ari R Ho-Foster
- 1 University of Pennsylvania, Philadelphia, Pennsylvania, USA
- 2 Botswana-UPenn Partnership, Gaborone, Botswana
| | | | | | | | | | - Lyla S Yang
- 5 Columbia University, New York City, New York, USA
| | - Lilo I Blank
- 6 University of Rochester, Rochester, New York, USA
| | - Vincent Ikageng Dipatane
- 7 Princess Marina Hospital, Gaborone, Botswana
- 8 Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Letumile Rogers Moeng
- 7 Princess Marina Hospital, Gaborone, Botswana
- 8 Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | | | | | - Frances K Barg
- 1 University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael B Blank
- 1 University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Philip Renison Opondo
- 1 University of Pennsylvania, Philadelphia, Pennsylvania, USA
- 9 University of Botswana School of Medicine, Gaborone, Botswana
| | - Lawrence H Yang
- 5 Columbia University, New York City, New York, USA
- 10 New York University, New York City, New York, USA
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234
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Promoting Integrated Mental Health Care Services in Disaster Response Programs: Lessons Learned After the Impact of Hurricane María in Puerto Rico. Disaster Med Public Health Prep 2019; 14:130-138. [PMID: 31429397 DOI: 10.1017/dmp.2019.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Meteorological and even human-made disasters are increasing every year in frequency and magnitude. The passage of a disaster affects a society without distinction, but groups with social vulnerability (low socioeconomic status, chronic medical, or psychological conditions, limited access to resources) face the most significant impact. As a result, psychological and behavioral symptoms (eg, depression and anxiety) can ensue, making the immediate response of mental health services crucial. Secondary data from a database of a temporary healthcare unit were analyzed. A total of 54 records were reviewed to collect information; univariate and bivariate analyses were done. The purpose of this article is to present our experience regarding the incorporation of a mental health services model, with its respective benefits and challenges, into a temporary healthcare unit, after Hurricane Maria in 2017.
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235
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Treichler EBH, Thomas ML, Bismark AW, Hochberger WC, Tarasenko M, Nungaray J, Cardoso L, Joshi YB, Zhang W, Sprock J, Swerdlow N, Cohen AN, Light GA. Divergence of subjective and performance-based cognitive gains following cognitive training in schizophrenia. Schizophr Res 2019; 210:215-220. [PMID: 30660574 PMCID: PMC7032664 DOI: 10.1016/j.schres.2018.12.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cognitive training is effective for improving cognitive performance among people with schizophrenia. An individual's perception of their own cognition is dissociable from performance on objective cognitive tests. Since subjective cognitive benefit may impact engagement, motivation, and satisfaction with time-intensive cognitive interventions, this study aimed to determine whether subjective cognitive difficulties improve in conjunction with cognitive gains following 30 h of cognitive training. METHODS Patients with schizophrenia or schizoaffective disorder (N = 46) were randomized to treatment as usual (TAU) or TAU augmented with auditory-targeted cognitive training (TCT). All participants completed assessment batteries at baseline and follow-up. As previously reported, the TCT group showed significant improvements in verbal learning and memory and reductions in auditory hallucinations relative to the TAU group. RESULTS Subjective cognitive difficulties did not significantly improve following TCT, even among TCT participants who showed improvements in cognitive performance (all ps > 0.05). Subjective cognitive difficulties were significantly associated with severity of depressive symptoms and hallucinations (r = 0.48 and r = 0.28, p < 0.001), but not global or specific domains of cognition (all rs < 0.1) at baseline. There were no significant relationships between change in subjective cognitive difficulties and change in cognitive or clinical variables (all ps > 0.05). DISCUSSION Patients with schizophrenia do not detect change in their cognition following cognitive training, even among those who showed robust gains in cognitive performance. Failure to detect improvement may undermine treatment engagement, motivation, and satisfaction. Translating score improvements on the cognitive exercises into tangible metrics, and providing ongoing, clinician-delivered feedback on performance may facilitate patient ability to detect improvements and improve motivation to engage with cognitive training interventions.
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Affiliation(s)
- Emily B. H. Treichler
- VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Michael L. Thomas
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Department of Psychology, Colorado State University, Fort Collins, CO
| | - Andrew W. Bismark
- VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - William C. Hochberger
- VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Melissa Tarasenko
- VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - John Nungaray
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Lauren Cardoso
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Yash B. Joshi
- VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Wen Zhang
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Joyce Sprock
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Neal Swerdlow
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Amy N. Cohen
- VA Desert Pacific MIRECC, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Gregory A. Light
- VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
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236
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Leung CJ, Fosuaah A, Frerichs J, Heslin M, Kabir T, Lee TMC, McGuire P, Meek C, Mouchlianitis E, Nath AS, Peters E, Shergill S, Stahl D, Trotta A, Yiend J. A qualitative study of the acceptability of cognitive bias modification for paranoia (CBM-pa) in patients with psychosis. BMC Psychiatry 2019; 19:225. [PMID: 31337373 PMCID: PMC6651961 DOI: 10.1186/s12888-019-2215-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/17/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cognitive Bias Modification (CBM) has been used successfully as a computer-based intervention in disorders such as anxiety. However, CBM to modify interpretations of ambiguous information relevant to paranoia has not yet been tested. We conducted a qualitative investigation of a novel intervention called CBM for paranoia (CBM-pa) to examine its acceptability in patients with psychosis. METHODS Eight participants with psychosis who completed CBM-pa were identified by purposive sampling and invited for a semi-structured interview to explore the facilitators and barriers to participation, optimum form of delivery, perceived usefulness of CBM-pa and their opinions on applying CBM-pa as a computerised intervention. The interviews were transcribed and analysed using thematic analysis by researchers working in collaboration with service users. RESULTS Themes emerged relating to participants' perception about delivery, engagement, programme understanding, factors influencing experience, perceived impact and application of CBM-pa. CBM-pa was regarded as easy, straightforward and enjoyable. It was well-accepted among those we interviewed, who understood the procedure as a psychological intervention. Patients reported that it increased their capacity for adopting alternative interpretations of emotionally ambiguous scenarios. Although participants all agreed on the test-like nature of the current CBM-pa format, they considered that taking part in sessions had improved their overall wellbeing. Most of them valued the computer-based interface of CBM-pa but favoured the idea of combining CBM-pa with some form of human interaction. CONCLUSIONS CBM-pa is an acceptable intervention that was well-received by our sample of patients with paranoia. The current findings reflect positively on the acceptability and experience of CBM-pa in the target population. Patient opinion supports further development and testing of CBM-pa as a possible adjunct treatment for paranoia. TRIAL REGISTRATION Current Controlled Trials ISRCTN: 90749868 . Retrospectively registered on 12 May 2016.
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Affiliation(s)
- C. J. Leung
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK ,0000000121742757grid.194645.bLaboratory of Neuropsychology, The University of Hong Kong, Hongkong, Hong Kong
| | - A. Fosuaah
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - J. Frerichs
- grid.490917.2The McPin Foundation, London, UK
| | - M. Heslin
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - T. Kabir
- grid.490917.2The McPin Foundation, London, UK
| | - T. M. C. Lee
- 0000000121742757grid.194645.bLaboratory of Neuropsychology, The University of Hong Kong, Hongkong, Hong Kong ,0000000121742757grid.194645.bThe State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hongkong, Hong Kong
| | - P. McGuire
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK ,0000 0001 2324 5535grid.415717.1South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK
| | - C. Meek
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - E. Mouchlianitis
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - A. S. Nath
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - E. Peters
- 0000 0001 2324 5535grid.415717.1South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK ,0000 0001 2322 6764grid.13097.3cDepartment of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S. Shergill
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK ,0000 0001 2324 5535grid.415717.1South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK
| | - D. Stahl
- 0000 0001 2322 6764grid.13097.3cDepartment of Biostatistics, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - A. Trotta
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - J. Yiend
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Salomon-Gimmon M, Orkibi H, Elefant C. Process and outcomes evaluation of a pre-academic arts program for individuals with mental health conditions: a mixed methods study protocol. BMJ Open 2019; 9:e025604. [PMID: 31324678 PMCID: PMC6661563 DOI: 10.1136/bmjopen-2018-025604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 06/06/2019] [Accepted: 06/21/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The Garage is a multidisciplinary pre-academic arts school for people with artistic abilities who are coping with mental health conditions (MHC). The programme, supported by the National Insurance Institute and the Ministry of Health in Israel, is an innovative rehabilitation service designed to impart and enhance artistic-professional skills and socioemotional abilities to ultimately facilitate participants' integration into higher education and the job market. METHODS AND ANALYSIS This mixed methods longitudinal study will include an embedded design in which the qualitative data are primary and the quantitative data are secondary, thus providing complementary information. The study will examine the contribution of the Garage to changes in participants' personal recovery, well-being, creative self-concept and community integration as well as possible mechanisms that may account for these changes. Qualitative data will be collected using focus groups with graduates and students (a total of ~60 participants). Quantitative data will be collected by self-report questionnaires only from students attending the programme (before, during and at the end of the academic year). Data on the graduates' integration into higher education and the job market after completing the programme will also be collected from the management team. The qualitative data will be analysed following the grounded theory approach and the quantitative data will be analysed with correlations, paired tests to examine pre-post changes and regression analyses. A merged data analysis will be conducted for data integration. ETHICS AND DISSEMINATION The University's Human Research Ethics Committee approved the design and procedures of the study (approval #357-16). All participants will sign an informed consent form where it is clarified that participation in the study is on a voluntary basis, and anonymity and confidentiality are guaranteed. The results will be submitted for peer-reviewed journal publications, presented at conferences and disseminated to the funder and the programme's management team.
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Affiliation(s)
| | - Hod Orkibi
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Cochavit Elefant
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
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Riblet N, Shiner B, Scott R, Bruce ML, Wasserman D, Watts BV. Exploring Psychiatric Inpatients' Beliefs About the Role of Post-discharge Follow-up Care in Suicide Prevention. Mil Med 2019; 184:e91-e100. [PMID: 29860477 PMCID: PMC8801294 DOI: 10.1093/milmed/usy129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 05/15/2018] [Indexed: 01/25/2023] Open
Abstract
Introduction: Patients are at increased risk for death by suicide following a psychiatric hospitalization. There has been limited study of the association between patient engagement in follow-up care after psychiatric hospitalization and suicide risk. Understanding why psychiatric inpatients choose to engage in post-discharge care is important in developing effective suicide prevention strategies. Materials and Methods: The theory of planned behavior (TPB) has been widely used to understand many health behaviors including healthcare utilization. Using the TPB, we developed an interview guide that assessed psychiatric inpatients’ attitudes and beliefs about the role of post-discharge care in addressing suicide risk. We also inquired about perception of future risk for suicide after discharge. We conducted semi-structured interviews prior to discharge and administered the Columbia-Suicide Severity Rating Scale (C-SSRS). We assessed healthcare utilization at 1 and 3 mo after discharge. We coded and grouped the transcribed data according to the three domains of the TPB model: attitudes, subjective norms, and perceived behavioral control. Results: Sixteen individuals consented to enrollment. More than half (N = 10) believed that they were at no or low future suicide risk after discharge. Participants who felt that their future risk for suicide was low or none were significantly older (mean 59.3 yr, SD: 8.3) and reported significantly less severe suicidal ideation in the past month (mean CSSR-S 2.5, SD 2.1) compared to those participants who believed that their future risk was high (mean age 47.5, SD: 8.6; mean CSSR-S 4.7, SD 0.5, p < 0.05). However, all participants had a lifetime history of severe suicidal ideation (mean CSSR-S > 4.7). Many participants felt that peers facilitated treatment engagement. However, participants expressed a tendency to avoid treatment if they experienced unwanted side effects, encountered stigma, or experienced poor-therapeutic alliance. Five participants experienced poor continuity of care after discharge. Of these participants, four reported at the time of discharge no or low perceived future risk of suicide and three were readmitted within 90 d after discharge. Conclusions: Individuals may not appreciate that they are at heightened risk for suicide after hospitalization and this may negatively impact treatment engagement.
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Affiliation(s)
- Natalie Riblet
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT.,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH.,The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH
| | - Brian Shiner
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT.,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH.,The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH
| | - Robert Scott
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT.,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH
| | - Martha L Bruce
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH.,The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill Health (NASP), Karolinska Instituet, Stockholm, Sweden
| | - Bradley V Watts
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH.,VA National Center for Patient Safety, 24 Frank Lloyd Wright Drive, Ann Arbor, MI
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239
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Florentin S, Rosca P, Raskin S, Bdolah-Abram T, Neumark Y. Psychiatric Hospitalizations of Chronic Psychotic Disorder Patients With and Without Dual Diagnosis, Israel, 1963-2016. J Dual Diagn 2019; 15:130-139. [PMID: 31079564 DOI: 10.1080/15504263.2019.1609149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: A significant proportion of patients with severe mental illness also experience substance use disorder. For these dual diagnosis (DD) patients, treatment is more complicated and prognosis is worse. Despite the introduction of the Community Rehabilitation of Persons With Mental Health Disability Law in 2000 and ongoing national mental health reforms, psychiatric services in Israel are not meeting the needs of an increasing number of DD patients. This study examines, for the first time in Israel, the prevalence of DD and patterns of psychiatric hospitalizations of chronic psychotic disorder patients with and without substance use disorder. Methods: The National Psychiatric Case Registry provided data on 18,684 persons with schizophrenia/schizoaffective disorders, aged 18-65, with a psychiatric hospitalization during the period 1963-2016 (with at least one hospitalization in 2010-15). Patients were considered as having DD if their substance use disorder was indicated in at least two, or 20%, of hospitalizations. Regression modeling predicted hospitalization measures (number of hospitalizations, total days hospitalized, length of stay). Results were also analyzed by legal status of admission (voluntary or involuntary; psychiatrist-ordered and court-ordered). Results: One-third of patients with chronic psychotic disorder met DD criteria, with a threefold higher rate among males (37.1%) than females (12.8%). Particularly high rates of DD (nearly 50%) were noted among male immigrants from Ethiopia. Compared with non-substance use disorder patients, DD patients had a significantly younger mean age at first hospitalization and shorter average length of stay per hospitalization but a greater number of hospitalizations and total hospital days (p < .0001 for all comparisons). The associations between DD status and hospitalization characteristics remained significant even after accounting for the effects of confounding factors. Hospitalization characteristics were also associated significantly with sex, population group, age, age at first hospitalization, and country of origin. The rate of court-ordered observation or hospitalization was threefold higher in the DD group. Conclusions: These findings, which broadly align with other countries, reflect a scarcity of outpatient services for DD patients with schizophrenia/schizoaffective disorder and substance use disorder. To achieve long-term mental health improvements, an expansion of community-based integrative treatment and rehabilitation services is needed in Israel.
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Affiliation(s)
- S Florentin
- The Hebrew University of Jerusalem , Jerusalem , Israel
| | - P Rosca
- Department for the Treatment of Substance Abuse, Ministry of Health , The Hebrew University of Jerusalem, Jerusalem , Israel
| | - S Raskin
- Jerusalem Mental Health Center, The Hebrew University of Jerusalem , Jerusalem , Israel
| | - T Bdolah-Abram
- Faculty of Medicine, The Hebrew University of Jerusalem , Jerusalem , Israel
| | - Y Neumark
- Hebrew University-Hadassah Braun School of Public Health & Community Medicine, The Hebrew University of Jerusalem , Jerusalem , Israel
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240
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Browne J, Mueser KT, Meyer-Kalos P, Gottlieb JD, Estroff SE, Penn DL. The therapeutic alliance in individual resiliency training for first episode psychosis: Relationship with treatment outcomes and therapy participation. J Consult Clin Psychol 2019; 87:734-744. [PMID: 31219276 DOI: 10.1037/ccp0000418] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The therapeutic alliance has long been considered an essential part of treatment. Despite a large body of work examining the alliance-outcome relationship, very few studies have examined it within individuals with first episode psychosis (FEP). METHOD The present study examined the alliance at Session 3, 4, or 5 and its relationship to 2-year treatment outcomes and therapy participation in a sample of 144 FEP clients who received specialized FEP treatment at U.S. clinics. Furthermore, we examined between-therapist and within-therapist (client) effects of the alliance on outcomes. RESULTS Results indicated that a better alliance was related to improved mental health recovery, psychological well-being, quality of life, total symptoms, negative symptoms, and disorganized symptoms at the end of treatment. In addition, the between-therapist effect of the alliance was significantly related to better mental health recovery whereas the within-therapist (client) effect of the alliance was related to better quality of life, total symptoms, and negative symptoms at the end of treatment. CONCLUSIONS A stronger alliance was related to improved treatment outcomes in FEP. Future work should consider examining mediators of the alliance-outcome relationship as well as how changes in the alliance relate to changes in outcomes over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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241
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Rimondini M, Busch IM, Mazzi MA, Donisi V, Poli A, Bovolenta E, Moretti F. Patient empowerment in risk management: a mixed-method study to explore mental health professionals' perspective. BMC Health Serv Res 2019; 19:382. [PMID: 31196085 PMCID: PMC6567542 DOI: 10.1186/s12913-019-4215-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 06/04/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In the last years, patients' empowerment has been increasingly recognized as a crucial dimension of patient-centered healthcare and patient safety. Nevertheless, little work has been done so far in the field of patient safety to investigate strategies for empowering psychiatric patients. Therefore, the aim of this study was to identify, by using focus groups, whether and how psychiatric patients' empowerment can improve risk management according to the perspective of healthcare providers (HPs). METHODS A mixed-method approach composed of a qualitative data collection method (i.e., focus groups) and a quantitative analysis technique (i.e., inductive content analysis) was applied. HPs working in mental health settings shared their perspectives on psychiatric patients' empowerment in risk management. After the transcription of the audio-taped discussions and the subsequent development of a hierarchical four-level coding system (strategy versus critical issue, thematic area, category, subcategory), two independent raters codified the transcripts and synthesized the content. Absolute frequencies are reported for quantitative data. RESULTS Twelve focus groups consisting of six to ten participants, each with an overall sample size of 95 participants (65 women; average age ± SD 47 ± 9 yrs), were enrolled. A total of 1252 participants' verbal contributions (i.e., units of analysis) were assessed. Strategies and critical issues (Level 1) were mentioned almost equally (52 and 48%, respectively) by the HPs. Most of the contributions at Level 2 referred to the thematic areas Treatment and Cure (69%) and Emergency Management (21%). In the area Treatment and Cure, the category Therapeutic Compliance (Level 3) was discussed in one third of all contributions. CONCLUSIONS Our results suggest that HPs consider patients as crucial partners in risk management and expect them to play a key role in actively enhancing safety. Policy makers should be aware that risk management in mental health settings particularly relies on the therapeutic relationship between HPs and patients. Therefore, allocating sufficient human and financial resources to mental health care aiming to further support the relationship between patients and HPs is of utmost importance.
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Affiliation(s)
- M. Rimondini
- Section of Clinical Psychology, Department of Biomedicine, Neuroscience and Movement, University of Verona, Verona, Italy
| | - I. M. Busch
- Section of Clinical Psychology, Department of Biomedicine, Neuroscience and Movement, University of Verona, Verona, Italy
| | - M. A. Mazzi
- Section of Clinical Psychology, Department of Biomedicine, Neuroscience and Movement, University of Verona, Verona, Italy
| | - V. Donisi
- Section of Clinical Psychology, Department of Biomedicine, Neuroscience and Movement, University of Verona, Verona, Italy
| | - A. Poli
- Section of Hygiene and Preventive Medicine, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - E. Bovolenta
- Section of Hygiene and Preventive Medicine, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - F. Moretti
- Section of Hygiene and Preventive Medicine, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
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242
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Ose SO, Færevik H, Kaasbøll J, Lindgren M, Thaulow K, Antonsen S, Burkeland O. Exploring the Potential for Use of Virtual Reality Technology in the Treatment of Severe Mental Illness Among Adults in Mid-Norway: Collaborative Research Between Clinicians and Researchers. JMIR Form Res 2019; 3:e13633. [PMID: 31199315 PMCID: PMC6598419 DOI: 10.2196/13633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/28/2019] [Accepted: 04/14/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Virtual reality (VR) technology is not currently used in the treatment of severe mental health illness in Norway. OBJECTIVE We aimed to explore the potential of VR as a treatment for severe mental health illness in Norway, through collaborative research between clinicians and researchers. METHODS A collaborative research team was established, comprising researchers, the manager at a district psychiatric center, and the manager of the local municipal mental health service. An all-day workshop with eight clinicians-four from specialist mental health services and four from municipal mental health services-was conducted. The clinicians watched three different VR movies and after each one, they answered predefined questions designed to reflect their immediate thoughts about VR's potential use in clinical practice. At the end of the workshop, two focus group interviews, each with four clinicians from each service level, were conducted. RESULTS VR technology in specialist services might be a new tool for the treatment of severe mental health illness. In municipal mental health services, VR might particularly be useful in systematic social training that would otherwise take a very long time to complete. CONCLUSIONS We found substantial potential for the use of VR in the treatment of severe mental health illness in specialist and municipal mental health services. One of the uses of VR technology with the greatest potential was helping individuals who had isolated themselves and needed training in social skills and everyday activity to enable them to have more active social lives. VR could also be used to simulate severe mental illness to provide a better understanding of how the person with severe mental illness experiences their situation.
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243
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Yamaguchi S, Ojio Y, Koike J, Matsunaga A, Ogawa M, Tachimori H, Kikuchi A, Kimura H, Inagaki A, Watanabe H, Kishi Y, Yoshida K, Hirooka T, Oishi S, Matsuda Y, Fujii C. Associations between readmission and patient-reported measures in acute psychiatric inpatients: a study protocol for a multicenter prospective longitudinal study (the ePOP-J study). Int J Ment Health Syst 2019; 13:40. [PMID: 31182972 PMCID: PMC6555753 DOI: 10.1186/s13033-019-0298-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023] Open
Abstract
Background Several previous observational studies have reported the risk factors associated with readmission in people with mental illness. While patient-reported experiences and outcomes have become increasingly important in healthcare, only a few studies have examined these parameters in terms of their direct association with readmission in an acute psychiatric setting. This project will investigate multiple factors associated with readmission and community living in acute psychiatric patients in Japan. This study will primarily investigate whether patient-reported experiences at discharge, particularly quality of life (QoL), are associated with future readmission and whether readmission after the index hospitalization is associated with changes in patient-reported outcomes during the study period. Here, we describe the rationale and methods of this study. Methods This multicenter prospective cohort study is being conducted in 21 participating Japanese hospitals, with a target sample of approximately 600 participants admitted to the acute psychiatric ward. The study has four planned assessment points: time of index admission (T1), time of discharge (from the index admission) (T2), 6 months after discharge from the index admission (T3), and 12 months after discharge from the index admission (T4). Participants will complete self-reported measures including a QoL scale, a subjective disability scale, and an empowerment- and self-agency-related scale at each assessment point; additionally, service satisfaction, subjective view of need for services, and subjective relationships with family members will be assessed at T2 and T3. We will assess the participants’ hospitalization during the study period and evaluate several potential individual- and service-level factors associated with readmission and patient-reported experiences and outcomes. Multivariate analyses will be conducted to identify potential associations between readmission and patient-reported experiences and outcomes. Discussion The present study may produce evidence on how patient-reported experiences at discharge influence readmission and on the influence of readmission on the course of patient-reported outcomes from admission to community living after discharge. The study may contribute to improving care for both patients’ subjective views of their own health conditions and their community lives in an acute psychiatric setting. Trial registration University Hospital Medical Information Network—Clinical Trials Registry (UMIN-CTR) UMIN000034220. Registered on September 20, 2018. Electronic supplementary material The online version of this article (10.1186/s13033-019-0298-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sosei Yamaguchi
- 1Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553 Japan
| | - Yasutaka Ojio
- 1Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553 Japan
| | - Junko Koike
- 1Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553 Japan
| | - Asami Matsunaga
- 1Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553 Japan
| | - Makoto Ogawa
- 1Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553 Japan
| | - Hisateru Tachimori
- 2Translational Medical Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553 Japan.,3The Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Akiko Kikuchi
- 1Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553 Japan
| | - Hiroshi Kimura
- 4Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan.,Department of Psychiatry, Gakuji-kai, Kimura Hospital, 6-19 Higashi-honcho, Chuo-ku, Chiba, 260-8670 Japan
| | - Ataru Inagaki
- 6College of Education, Psychology and Human Studies, Aoyama Gakuin University, 4-4-25 Shibuya, Shibuya-ku, Tokyo, 150-8366 Japan
| | - Hiroyuki Watanabe
- Department of Psychiatry, Gakuji-kai, Kimura Hospital, 6-19 Higashi-honcho, Chuo-ku, Chiba, 260-8670 Japan.,7Division of Medical Treatment and Rehabilitation, Center of Forensic Mental Health, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
| | - Yoshiki Kishi
- 8Department of Psychiatry, Okayama Psychiatric Medical Center, 3-16 Shikata-Honmachi, Kita-ku, Okayama, Japan
| | - Koji Yoshida
- 9Department of Human Care and Support, Toyo University, 48-1 Oka, Asaka, 351-8510 Japan
| | - Takaaki Hirooka
- 10Department of Psychiatry, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami, Sagamihara, 252-0374 Japan
| | - Satoru Oishi
- 10Department of Psychiatry, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami, Sagamihara, 252-0374 Japan
| | - Yasuhiro Matsuda
- 11Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijo, Kashihara, 634-8521 Japan
| | - Chiyo Fujii
- 1Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553 Japan
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Fortuna KL, Brooks JM, Umucu E, Walker R, Chow PI. Peer Support: a Human Factor to Enhance Engagement in Digital Health Behavior Change Interventions. ACTA ACUST UNITED AC 2019; 4:152-161. [PMID: 34337145 DOI: 10.1007/s41347-019-00105-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this report is to develop a theoretical model based on empirical evidence that can serve as a foundation for the science of peer-support factors that facilitate engagement in digital health interventions for people with serious mental illness (SMI). A review of the literature on how peer-support specialist interaction with consumers with SMI in digital health behavior change interventions enhances engagement. Unlike relationships with other health providers, peer-to-consumer relationships are based on reciprocal accountability -meaning that peer-support specialists and consumer mutually help and learn from each other. Under the recovery model of mental illness, reciprocal accountability suggests autonomy, flexible expectations, shared lived experience, and bonding influence engagement in digital interventions. Separate yet related components of reciprocal accountability in the context of digital health intervention engagement include (1) goal setting, (2) task agreement, and (3) bonding. Hope and sense of belonging are hypothesized moderators of peer-support factors in digital health interventions. Peer-support factors help people with SMI learn to live sucessfully both in the clinic and community. Peer-support specialists add value and complement traditional mental health treatment through their professional training and lived experience with a mental illness. The proposed model is a pioneering step towards understanding how peer-support factors impact engagement in digital health behavior change interventions among people with a lived experience of SMI. The model presents proposed factors underlying the reciprocal accountability processes in the context of digital health intervention engagement. This model and related support factors can be used to examine or identify research questions and hypotheses.
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Affiliation(s)
- Karen L Fortuna
- The Geisel School of Medicine at Dartmouth, 2 Pillsbury Street, Suite 401, Concord, NH 03301, USA.,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH 03766, USA
| | - Jessica M Brooks
- James J. Peters VA Medical Center, Geriatric Research, Education and Clinical Center, 130 W Kingsbridge Rd, The Bronx, NY, USA
| | - Emre Umucu
- Department of Rehabilitation Sciences, University of Texas at El Paso, 500 W University Ave, El Paso, TX 79968, USA
| | - Robert Walker
- Massachusetts Department of Mental Health, Office of Recovery, 25 Staniford St, Boston, MA 02114, USA
| | - Phillip I Chow
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
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245
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Patient-Centered Values and Experiences with Emergency Department and Mental Health Crisis Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:611-622. [PMID: 29383464 DOI: 10.1007/s10488-018-0849-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Little is known about what patients value in psychiatric crisis services or how they compare community-based services with those received in the emergency department. Three focus groups (n = 27) were held of participants who had received psychiatric crisis services in emergency departments or a community mental health center. Participants described care experiences and preferences. Focus groups were audio recorded, transcribed, and coded using a value-based lens. Themes included appreciation for feeling respected, basic comforts, and shared decision-making as foundations of quality care. Participants preferred the community mental health center. Research should address long-term outcomes to motivate change in psychiatric crisis care.
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246
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Hansen H, Stige SH, Moltu C, Johannessen JO, Joa I, Dybvig S, Veseth M. "We all have a responsibility": a narrative discourse analysis of an information campaign targeting help-seeking in first episode psychosis. Int J Ment Health Syst 2019; 13:32. [PMID: 31086563 PMCID: PMC6507175 DOI: 10.1186/s13033-019-0289-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/30/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Intervening at an early stage of psychosis improves the chances of recovery from first-episode psychosis. However, people who are experiencing distress and early psychotic symptoms generally seem to delay seeking help. Therefore, multifaced information campaigns targeting help-seeking behavior of potential patients and their network are considered important tools within early detection and intervention strategies. In this study, we aimed to explore which discursive meaning content, including roles and actors, such information campaigns build on and construct. Our intention was not to provide objective answers, but to contribute to a discursive debate about potential conflicts in messages conveyed in such campaigns. METHODS A broad sample of information material utilized by TIPS Stavanger University Hospital (Norway) was examined. The material consisted of posters, booklets and brochures, newspaper ads, Facebook ads, and TIPS Info's website, representing various campaigns from 1996 to April 2018. A narrative discursive approach was applied at an epistemological level. At a practical level, a team-based thematic analysis was utilized to identify patterns across data. RESULTS Diversity and several changes in strategy were recognized throughout the information material. Furthermore, three main themes and four subthemes were found to constitute the meaning content built in the information campaigns: knowledge is key; (almost) an illness among illnesses; and we all have a responsibility (comprising of the subthemes; to respond quickly; to step in; to provide an answer; and to tag along). CONCLUSION Our findings pointed to common dilemmas in mental health services: How to combine professional expert knowledge with collaborative practices that emphasize shared decision-making and active roles on behalf of patients? How to combine a focus on symptoms and illness and simultaneously express the importance of addressing patients' recourses? And how can we ask for societal responsibility in help-seeking when professionals are placed in expert positions which may not be optimal for dialogue with potential patients or their network? We discuss whether highlighting practices with more weight on resources and active roles for patients and their surroundings in information campaigns could promote earlier help-seeking.
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Affiliation(s)
- Hege Hansen
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Postbox 7030, 5020 Bergen, Norway
| | | | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Jan Olav Johannessen
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Inge Joa
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Sveinung Dybvig
- TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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247
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McKenna RM, Pintor JK, Ali MM. Insurance-Based Disparities In Access, Utilization, And Financial Strain For Adults With Psychological Distress. Health Aff (Millwood) 2019; 38:826-834. [DOI: 10.1377/hlthaff.2018.05237] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ryan M. McKenna
- Ryan M. McKenna is an assistant professor of health management and policy at the Drexel University Dornsife School of Public Health, in Philadelphia, Pennsylvania
| | - Jessie Kemmick Pintor
- Jessie Kemmick Pintor is an assistant professor of health management and policy at the Drexel University Dornsife School of Public Health
| | - Mir M. Ali
- Mir M. Ali is an economist at the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, in Washington, D.C
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248
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Sparrow-Downes VM, Loutfy M, Antoniou T, Vigod SN. Postpartum mental health service utilization in women with Human Immunodeficiency Virus (HIV): a population-based study. AIDS Care 2019; 31:1332-1339. [PMID: 31035793 DOI: 10.1080/09540121.2019.1612007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Women with HIV have higher rates of psychiatric disorders than HIV-negative women, yet little is known about their postpartum mental health and associated service use. The purpose of this study was to characterize HIV-positive women's use of ambulatory and acute mental health services in the first year postpartum, relative to HIV-negative women. Using health administrative data, we identified 861,365 women who had a live birth delivery from April 1, 2002 to March 31, 2012 in Ontario, Canada, of whom 530 were identified to be HIV-positive. We described their use of mental health services, including outpatient mental health visits, psychiatric emergency department (ED) visits and hospitalizations using adjusted odds ratios (aORs) and 95% confidence intervals (CIs). HIV-positive women were more likely to access outpatient mental health services (31.5% vs. 21.0%, aOR, 1.26; 95% CI, 1.03-1.55), but more likely to remain engaged in psychiatrist services only (15.6% vs. 6.5%, aOR, 2.35; 95% CI, 1.41-3.72). They were also more likely to require a psychiatric ED visit or hospitalization (3.3% vs. 1.1%, aOR, 2.74; 95% CI, 1.72-4.12). Our findings highlight the importance of considering postpartum mental health as part of comprehensive reproductive health care for women with HIV.
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Affiliation(s)
| | - Mona Loutfy
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Canada.,ICES, University of Toronto , Toronto , Canada.,Women's College Research Institute, Women's College Hospital , Toronto , Canada.,Faculty of Medicine, University of Toronto , Toronto , Canada
| | | | - Simone N Vigod
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Canada.,ICES, University of Toronto , Toronto , Canada.,Women's College Research Institute, Women's College Hospital , Toronto , Canada.,Faculty of Medicine, University of Toronto , Toronto , Canada
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Chinman M, McCarthy S, Mitchell-Miland C, Bachrach RL, Schutt RK, Ellison M. Predicting Engagement With Mental Health Peer Specialist Services. Psychiatr Serv 2019; 70:333-336. [PMID: 30755129 DOI: 10.1176/appi.ps.201800368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Peer specialists are individuals with behavioral disorders who complete training to use their experiences to help others with similar disorders. Recent analyses have suggested that greater engagement with peer specialist services is associated with fewer psychiatric symptoms. This study assessed predictors of engagement with peer specialist services. METHODS Using the Andersen model of health service utilization with a sample of veterans (N=71) receiving housing support, investigators constructed a negative binomial regression model to evaluate the association between peer specialist service engagement and the model's three factors assessed at baseline of a larger trial: predisposing (personal demographic and social variables); enabling (support variables), and need (perceived and evaluated health problems). Demographic characteristics and behavioral health service use six months before baseline were also predictors. RESULTS Greater hope (predisposing), psychiatric symptoms (need), and service utilization significantly predicted greater peer specialist engagement. CONCLUSIONS These results suggest subpopulations with whom peer specialists would be most likely to engage successfully, perhaps improving their efficiency.
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Affiliation(s)
- Matthew Chinman
- Center for Health Equity Research and Promotion and the Mental Illness Research, Education, and Clinical Center (Chinman, Mitchell-Miland, Bachrach) and Department of Health Science (McCarthy), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh; Department of Health, RAND Corporation, Santa Monica, California (Chinman); Department of Sociology (Schutt) and Department of Psychiatry (Ellison), University of Massachusetts, Boston
| | - Sharon McCarthy
- Center for Health Equity Research and Promotion and the Mental Illness Research, Education, and Clinical Center (Chinman, Mitchell-Miland, Bachrach) and Department of Health Science (McCarthy), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh; Department of Health, RAND Corporation, Santa Monica, California (Chinman); Department of Sociology (Schutt) and Department of Psychiatry (Ellison), University of Massachusetts, Boston
| | - Chantele Mitchell-Miland
- Center for Health Equity Research and Promotion and the Mental Illness Research, Education, and Clinical Center (Chinman, Mitchell-Miland, Bachrach) and Department of Health Science (McCarthy), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh; Department of Health, RAND Corporation, Santa Monica, California (Chinman); Department of Sociology (Schutt) and Department of Psychiatry (Ellison), University of Massachusetts, Boston
| | - Rachel L Bachrach
- Center for Health Equity Research and Promotion and the Mental Illness Research, Education, and Clinical Center (Chinman, Mitchell-Miland, Bachrach) and Department of Health Science (McCarthy), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh; Department of Health, RAND Corporation, Santa Monica, California (Chinman); Department of Sociology (Schutt) and Department of Psychiatry (Ellison), University of Massachusetts, Boston
| | - Russell K Schutt
- Center for Health Equity Research and Promotion and the Mental Illness Research, Education, and Clinical Center (Chinman, Mitchell-Miland, Bachrach) and Department of Health Science (McCarthy), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh; Department of Health, RAND Corporation, Santa Monica, California (Chinman); Department of Sociology (Schutt) and Department of Psychiatry (Ellison), University of Massachusetts, Boston
| | - Marsha Ellison
- Center for Health Equity Research and Promotion and the Mental Illness Research, Education, and Clinical Center (Chinman, Mitchell-Miland, Bachrach) and Department of Health Science (McCarthy), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh; Department of Health, RAND Corporation, Santa Monica, California (Chinman); Department of Sociology (Schutt) and Department of Psychiatry (Ellison), University of Massachusetts, Boston
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Abstract
The doctor-patient relationship is crucial to the health-care delivery. In the past, the relationship was viewed as one between a healer and a sick person. However, in the modern era, it is seen as an interaction between a care provider and a service user. The Mental Healthcare Act (MHCA) 2017 gives importance to rights and provision for more autonomy to patients. We examined, in the context of the existing literature, the potential impact the implementation of MHCA 2017 can have on the doctor-patient relationship. A bond between doctor and patient that is based on trust has been an integral part of patient care and has been described to promote recovery, reduce relapse, and enhance treatment adherence. Growing mistrust among patients toward doctors leads them to change their doctors frequently, and due to this, the patients are at risk of losing the therapeutic benefit of the doctor-patient relationship. The doctor-patient relationship has been understudied in areas of health-care need, such as in rural areas, where accessibility and availability of care itself become the most important goal. Medical advancement, with several new treatment options, as well as the availability of many experts for patients to choose from, seems a boon turning into a bane. MHCA 2017 and other health-care policies so far have not given importance to this relationship that is being damaged by several factors including rising health-care costs, especially in private sector and after patients have become "consumers." However, for now, the foremost thing is the psychiatrists have to work to comply with the law and document to justify clinical decisions.
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Affiliation(s)
- Vijaykumar Harbishettar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - K. R. Krishna
- Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, Karnataka, India
| | | | - Mahesh Gowda
- Spandana Health Care, Bengaluru, Karnataka, India
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