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Klauber DG, Christensen SH, Fink-Jensen A, Pagsberg AK. I Didn't Want the Psychotic Thing to Get Out to Anyone at All: Adolescents with Early Onset Psychosis Managing Stigma. Cult Med Psychiatry 2024:10.1007/s11013-024-09859-3. [PMID: 38869653 DOI: 10.1007/s11013-024-09859-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/14/2024]
Abstract
The impact of stigmatisation on adults with mental illnesses has been thoroughly demonstrated. However, little is known about experiences of stigmatisation among adolescents with mental illness. Through semi-structured interviews with 34 Danish adolescents (14-19 years) diagnosed with psychosis, this study explores adolescents' experiences of psychosis stigma. On the basis of phenomenological analysis, we find that stigmatisation is widely experienced, and psychosis is generally regarded as more stigmatising than co-morbid mental illnesses. The participants engage in different strategies to manage possible stigma, especially strategies of (non-)disclosure. Disclosure is experienced as both therapeutic and normative, but also bears the risk of stigmatisation, and is therefore associated with numerous considerations. Being understood when disclosing is central to the participants, and lack of understanding from others is a continuous challenge. Nevertheless, participants experience benefits when feeling understood by people they confide in and can to a degree create the grounds for this through centralising aspects of their experiences of psychosis and mental illness. We argue that disclosure is both a stigma management strategy and a normative imperative, and that being understood or not is a challenge transcending stigma definitions.Clinical trial registration: Danish Health and Medicines Authority: 2612-4168. The Ethics Committee of Capital Region: H-3-2009-123. ClinicalTrials.gov: NCT01119014. Danish Data Protection Agency: 2009-41-3991.
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Affiliation(s)
- Dea Gowers Klauber
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Sofie Heidenheim Christensen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
| | - Anders Fink-Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
- Laboratory of Neuropsychiatry, Department of Neuroscience and Pharmacology, University of Copenhagen, Nordre Ringvej 26-67, 2600, Glostrup, Denmark
- Psychiatric Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
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Attaran Kakhki N, Garber P, Dudubo O, Salem A, Carnevale FA, Macdonald ME. Enhancing children's participation in dental research: A commentary. Community Dent Oral Epidemiol 2024. [PMID: 38693594 DOI: 10.1111/cdoe.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
The concept of childhood has evolved over the years, inspired by the United Nations Convention on the Rights of the Child in 1989, shifting from developmental models to a conception of childhood that recognizes children as moral agents. This evolution highlights the importance of respecting children's agency and their right to be heard in matters that are related to them. In conventional health research, however, children's voices are often inadequately accessed. In this commentary, we discuss the imperative to recognize children's agency in dental research and a shift from research on children to research with and by children. Moreover, we underscore the importance of actively seeking and listening to children's voices and recognizing their agency in shaping research and healthcare practices in the field of dentistry. Further, we explore the application of participatory research approaches in dental research and provide examples of studies that have involved children in various capacities. We conclude this commentary by emphasizing the potential benefits of participatory research in both qualitative and quantitative dental studies to promote deeper understanding, clearer communication, and stronger advocacy regarding children's interests. Primarily, we call for greater recognition of children's agency in dental research and advocate for more inclusive and child-centred research methodologies.
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Affiliation(s)
- Nona Attaran Kakhki
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Peter Garber
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Olawale Dudubo
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Asma Salem
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
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Walker SJ, Hester M, McCarthy E. The Use of Chemical Control Within Coercive Controlling Intimate Partner Violence and Abuse. Violence Against Women 2023; 29:2730-2753. [PMID: 37661810 PMCID: PMC10557365 DOI: 10.1177/10778012231197579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
This paper explores the use of chemical control by perpetrators as part of coercive controlling intimate partner violence and abuse, defined as the nonconsenting use of prescribed and nonprescribed medication (including vaccines), and/or other substances to coerce or control, reducing the victim-survivor's capacity for independence, freedom, and health. Based on testimonies of 37 victims-survivors and nine domestic abuse practitioners in the UK we identify varying tactics used to chemically coerce and control, deepening our understanding about the continually changing forms of domestic violence and abuse and enhancing the potential for a more robust response through better informed policy and practice.
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Sikstrom L, Maslej MM, Findlay Z, Strudwick G, Hui K, Zaheer J, Hill SL, Buchman DZ. Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry. BMJ Open 2023; 13:e069255. [PMID: 37185650 PMCID: PMC10151964 DOI: 10.1136/bmjopen-2022-069255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Managing violence or aggression is an ongoing challenge in emergency psychiatry. Many patients identified as being at risk do not go on to become violent or aggressive. Efforts to automate the assessment of risk involve training machine learning (ML) models on data from electronic health records (EHRs) to predict these behaviours. However, no studies to date have examined which patient groups may be over-represented in false positive predictions, despite evidence of social and clinical biases that may lead to higher perceptions of risk in patients defined by intersecting features (eg, race, gender). Because risk assessment can impact psychiatric care (eg, via coercive measures, such as restraints), it is unclear which patients might be underserved or harmed by the application of ML. METHODS AND ANALYSIS We pilot a computational ethnography to study how the integration of ML into risk assessment might impact acute psychiatric care, with a focus on how EHR data is compiled and used to predict a risk of violence or aggression. Our objectives include: (1) evaluating an ML model trained on psychiatric EHRs to predict violent or aggressive incidents for intersectional bias; and (2) completing participant observation and qualitative interviews in an emergency psychiatric setting to explore how social, clinical and structural biases are encoded in the training data. Our overall aim is to study the impact of ML applications in acute psychiatry on marginalised and underserved patient groups. ETHICS AND DISSEMINATION The project was approved by the research ethics board at The Centre for Addiction and Mental Health (053/2021). Study findings will be presented in peer-reviewed journals, conferences and shared with service users and providers.
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Affiliation(s)
- Laura Sikstrom
- The Krembil Centre for Neuroinformatics, The Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Marta M Maslej
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Zoe Findlay
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hui
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sean L Hill
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Macdonald ME, Bertrand A, Brousseau-Bellavance L, Bruder-Wexler A, Liu K, Rosberg M, Carnevale FA. Research, policy making, and practice with young people. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:161-164. [PMID: 36890409 PMCID: PMC10036696 DOI: 10.17269/s41997-023-00756-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
| | - Ariane Bertrand
- VOICE Youth Advisory Council, McGill University, Montreal, QC, Canada
| | | | | | - Kevin Liu
- VOICE Youth Advisory Council, McGill University, Montreal, QC, Canada
| | - Miriam Rosberg
- VOICE Youth Advisory Council, McGill University, Montreal, QC, Canada
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Clarke T, Platt R. Children's Lived Experiences of Wellbeing at School in England: a Phenomenological Inquiry. CHILD INDICATORS RESEARCH 2023; 16:963-996. [PMID: 37274807 PMCID: PMC9981449 DOI: 10.1007/s12187-023-10016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 06/07/2023]
Abstract
This phenomenological inquiry investigated children's wellbeing experiences at school, including their hedonic (feeling good) and eudaimonic (doing good) accounts, a distinction often overlooked. Further, while phenomenological inquiries of children's mental ill-health exist, wellbeing, a fundamental part of mental health, is neglected. This is at odds with positive psychology which favours strengths-based approaches to studying human development. Phenomenology provides rich detail, facilitating deeper understanding of why and how certain factors affect wellbeing, as described by children themselves. A sample of 15 children (aged 9-11), attending one English primary school broadly representative of the national socio-demographic, engaged in interviews. Children's experiences of 'feeling good' at school were characterised by: an interdependence on peers' emotional states (described as 'a domino effect'), a need to feel cared for by, and trust, adults, and desire for autonomy over their time. Children attributed mistrust in adults to adults disregarding seemingly incidental events which felt significant to children. Children experienced 'doing well' as equating to academic attainment, conveying a fixation with test scores, using language of 'correctness' and efficiency. Shame pervaded when 'correctness' was not achieved, with children describing being ridiculed for poor test scores. Recommendations for schools to support children's hedonia include prioritising wellbeing curricula and emotional literacy, greater staff reflexivity, and prioritisation of pupil voice. To foster children's eudaimonia, recommendations include the need for teachers to provide formative, personalised feedback for pupils focused on the learning process, and the need for Government to embrace a range of ways pupils can feel successful beyond academic attainment. Supplementary Information The online version contains supplementary material available at 10.1007/s12187-023-10016-2.
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Affiliation(s)
- Tania Clarke
- Faculty of Education, University of Cambridge, 184 Hills Rd, Cambridge, CB2 8PQ UK
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Njelesani J, Mlambo V, Denekew T, Hunleth J. Inclusion of children with disabilities in qualitative health research: A scoping review. PLoS One 2022; 17:e0273784. [PMID: 36048816 PMCID: PMC9436059 DOI: 10.1371/journal.pone.0273784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 08/15/2022] [Indexed: 11/21/2022] Open
Abstract
Background Children with disabilities have the right to participate in health research so their priorities, needs, and experiences are included. Health research based primarily on adult report risks misrepresenting children with disabilities and their needs, and contributes to exclusion and a lack of diversity in the experiences being captured. Prioritizing the participation of children with disabilities enhances the relevance, meaningfulness, and impact of research. Methods A scoping review was conducted to critically examine the participation of children with disabilities in qualitative health research. The electronic databases PubMed, PsychInfo, Embase, and Google Scholar were searched. Inclusion criteria included qualitative health studies conducted with children with disabilities, published between 2007 and 2020, and written in English. Articles were screened by two reviewers and the synthesis of data was performed using numeric and content analysis. Results A total of 62 studies met inclusion criteria. Rationales for including children with disabilities included child-focused, medical model of disability, and disability rights rationales. Participation of children with disabilities in qualitative health research was limited, with the majority of studies conducting research on rather than in partnership with or by children. Findings emphasize that children with disabilities are not participating in the design and implementation of health research. Conclusion Further effort should be made by health researchers to incorporate children with a broad range of impairments drawing on theory and methodology from disability and childhood studies and collaborating with people who have expertise in these areas. Furthermore, an array of multi-method inclusive, accessible, adaptable, and non-ableist methods should be available to enable different ways of expression.
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Affiliation(s)
- Janet Njelesani
- Department of Occupational Therapy, New York University, New York, NY, United States of America
- * E-mail:
| | - Vongai Mlambo
- Stanford University School of Medicine, Stanford, CA, United States of America
| | | | - Jean Hunleth
- Division of Public Health Sciences. Washington University in St. Louis, St. Louis, MO, United States of America
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