Determinants, self-management strategies and interventions for hope in people with mental disorders: systematic search and narrative review

Subjective experiences of an acceptance and mindfulness-based group intervention (Feel-Good-Group) in young people with early psychosis

Background

Mindfulness-based interventions are promising psychological treatment approaches that may have more substantial long-lasting intervention effects than cognitive behavioral therapy when treating individuals with early psychosis. A pilot study analyzed mindfulness-based inpatient group therapy's feasibility and potential efficacy (Feel-Good).

Objective

This paper explores the subjective experiences of participants in the Feel-Good inpatient therapy group to gain insight into the possible changes brought about by the mindfulness-based intervention.

Methods

A semi-structured change interview was used to examine the experience of ten participants who participated in the Feel-Good intervention and the additional qualitative assessment. The interviews were conducted 16 weeks after the Feel-Good group ended (16-week Follow-Up). Interviews were transcribed verbatim and analyzed using thematic analysis.

Results

The analysis generated five themes-one about personal changes brought about by the Feel-Good group, three about the group therapy experience, and one about wishes/modification suggestions to change and improve the Feel-Good group. The findings suggested that the Feel-Good group was perceived as very helpful, leading to numerous changes in one's overall well-being and relation to emotions. However, patients recommended a more directive therapeutic style and reduced time required for study assessments.

Conclusion

Gathering qualitative insight from participants on the Feel-Good intervention revealed meaningful insight into patients' experience of change processes. In addition, participant suggestions help to improve the intervention and study design to increase therapy attendance rates and treatment satisfaction, potentially increasing treatment effectiveness in the future.

Clinical trial registration

ClinicalTrials.gov, identifier NCT04592042.

Distal supports, capabilities, and growth-focused recovery: A comparison of Housing First and the staircase continuum of care

Adults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of "distal support" that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth-related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth-focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth-related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods.

The co-construction and emotion management of hope within psychosis services

Introduction

There is a growing acknowledgement of the salience of hope for mental health service-users, in influencing care outcomes and recovery. Understandings of the processes through which hopes are co-constructed, alongside specific conceptualisations of experiences of hoping, remain limited however.

Methods

This qualitative study explored how a range of stakeholders experienced and dealt with uncertainty within three purposively selected psychosis services in southern England. In this article we focus particularly on the co-construction of hope within participants' narratives and how this emotion work shaped experiences of hoping. In-depth interviews (n = 23) with service-users, professionals, managers and other stakeholders were analysed following a phenomenological approach.

Findings

Hope was spontaneously identified by participants as a fundamental mechanism through which service-users and professionals managed uncertainty when vulnerable. Professionals were influential in shaping users' hopes, both intentionally and unwittingly, while some professionals also referred to managing their own hopes and those of colleagues. Such management of expectations and emotions enabled motivation and coping amidst uncertainty, for users and professionals, but also entailed difficulties where hope was undermined, exaggerated, or involved tensions between desires and expectations.

Discussion

Whereas, hope is usually reflected in the caring studies literature as distinctly positive, our findings point to a more ambivalent understanding of hope, as reflected in the accounts of both service-users and professionals where elevated hopes were described as unrealistic and harmful, to the well-being of professionals as well as of service-users. It is concluded that a greater awareness within care contexts of how hopes are co-constructed by professionals and service-users, explicitly and implicitly, can assist in improving health care and healthcare outcomes.

Personal recovery associated with deep brain stimulation for treatment-resistant depression: A constructivist grounded theory study

WHAT IS KNOWN ON THE SUBJECT?: Major depressive disorder is the most prevalent of all mental illnesses. 10%-20% of patients with depression and 1% of the population overall have treatment-resistant depression (TRD). DBS is an emerging investigational treatment for TRD with documented clinical efficacy and safety. The framework of the recovery model includes both clinical and personal recovery. Personal recovery is a self-process in which hope, empowerment and optimism are embraced to overcome the impact of mental illness on one's sense of self. Although clinical and functional outcomes of DBS for TRD have been well documented in the previous studies, personal recovery as an outcome has been explored only in a handful of studies. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first qualitative study exploring personal recovery from DBS treatment specific to the target of subcallosal cingulate cortex in patients with TRD. Since the existing literature on personal recovery in DBS studies is limited, the contribution of this paper is crucial to this field. For individuals who responded to deep brain stimulation clinically, neither participants nor family believed it cured their depression, but rather there was a significant decrease in the severity of symptoms of depression. A holistic-oriented framework (that includes personal recovery) is significant for those individuals with TRD undergoing DBS. Personal and clinical recovery are two different constructs, and individuals may experience one or the other or both. The experience of participants who responded to deep brain stimulation recognized that the recovery from depression is a process of reconstructing self. This process involved a period of adjustment that evoked a deeper self-awareness, re-engagement with daily living and newfound gratitude in living. Individuals transitioned from an emotionally driven life to one where future goals were considered. Supportive relationships were instrumental in this process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A deep brain stimulation intervention for treatment-resistant depression offered individuals an opportunity for personal recovery where a reconstruction of self occurred. Personal recovery can be considered as an outcome in conjunction with clinical and functional outcomes in future DBS trials for TRD. The relevance of personal recovery in the prevention of relapses needs further investigation. To advocate for care and services that facilitate the process of recovery from depression, it is important to understand the personal dimensions and experience of recovery that may influence the process. To develop recovery-oriented interventions to help patients and families in recovery post-deep brain stimulation, further understanding of support and negotiating relationships during this life-altering experience is needed. ABSTRACT: Introduction Multiple trials of antidepressant treatments in patients with depression pose a major challenge to the mental health system. Deep brain stimulation (DBS) is an emerging and promising investigational treatment to reduce depressive symptoms in individuals with treatment-resistant depression (TRD). The clinical and functional outcomes of DBS for TRD have been well documented in previous studies; however, studies of personal recovery as an outcome of DBS specific to the target of subcallosal cingulate cortex in patients with TRD are limited. Aim To explore the processes of personal recovery in patients with treatment-resistant depression following subcallosal cingulate-deep brain stimulation. Method Participants were 18 patients with TRD who participated in the subcallosal cingulate (SCC)-DBS trial and 11 family members. They also participated in add-on individual cognitive behavioural therapy during the trial. A qualitative constructivist grounded theory approach was used to conceptualize the personal recovery process of patients and families. Results While every participant and their families' journey were unique following the deep brain stimulation intervention, a theoretical model of Balancing to Establish a Reconstructed Self emerged from the data. The themes underlying the model were (1) Balancing to Establish a Reconstructed Self: A Whole-Body Experience, (2) The Liminal Space in-between: Balancing with Cautious Optimism, (3) Hope: Transitioning from Emotion-Focussed Living to Goal-Oriented Planning and (4) Support: Negotiating Relationships. Discussion This is the first study examining recovery from patients' perspectives as an outcome of SCC-DBS intervention for TRD. The study shows that personal recovery is a gradual and continual process of reconstruction of the self, developing through supportive relationships. Clinical and personal recovery are two distinct constructs, and individuals may experience one or the other or both. Most patients who do respond clinically experience improvement in terms of having optimism and hope. Some patients, however, respond with significant symptom reduction but are not able to achieve personal recovery to experience joy or hope for improved quality of living. Implications for Practice Strategies for personal recovery for both patients and family need to be considered during and post deep brain stimulation intervention. Nurses working with these patients and families may benefit from education, training and support to assess and engage in conversations about their recovery process.

Sense of mastery in first-episode psychosis-a one-year follow-up study

Introduction

A sense of mastery refers to beliefs about having control over one's life and has been found to protect health and buffer the effect of stressful experiences.

Methods

We investigated sense of mastery in first-episode psychosis (FEP) patients and population controls at baseline and at one-year follow-up. Pearlin and Schooler's Sense of Mastery scale was completed by 322 participants at baseline and by 184 participants at follow-up.

Results

People having experienced FEP reported lower mastery than controls at both time points, but a modest increase was seen in patients at follow-up. The strongest correlates of high baseline mastery in FEP were lower depressive symptoms and higher perceived social support, whereas positive or negative psychotic symptoms did not associate with mastery. Current depressive symptoms also correlated with mastery at the follow-up point, and change in depressive symptoms correlated with change in mastery. Higher mastery at treatment entry predicted remission of psychotic symptoms one year later. Sense of mastery was also found to mediate the association of perceived social support with depressive symptoms.

Discussion

The usefulness of mastery measures should be further tested for estimations of patient prognosis in early psychosis.

Risk, resilience, and recovery in forensic mental health: An integrated conceptual model

In this paper we describe a novel, integrated conceptual model that brings together core elements across structured tools assessing risk for future violence, protective factors, and progress in treatment and recovery in forensic mental health settings. We argue that the value of such a model lies in its ability to improve clinical efficiencies and streamline assessment protocols, facilitate meaningful participation of patients in assessment and treatment planning activities and increase the accessibility of clinical assessments to principal users of this information. The four domains appearing in the model (treatment engagement, stability of illness and behavior, insight, and professional and personal support) are described, and common clinical manifestations of each domain within a forensic context are illustrated. We conclude with a discussion of the types of research that would be needed to validate a concept model such as the one presented here as well as implications for clinical practice and implementation.

Hope, proactive personality, coping styles, and satisfaction with life among veterans during COVID-19

Veterans of the U.S. Armed Forces are an at-risk population given their increased mental health concerns resulting from their military service. However, there has been limited research conducted with this population during the novel coronavirus (COVID-19) pandemic. The purpose of this exploratory study was to examine aspects of positive psychological functioning with 132 U.S. veterans during COVID-19 using Lazarus and Folkman's (1984) transactional model of stress and coping. Specifically, we examined the personal resources of hope and proactive personality, two coping styles, and satisfaction with life. We performed correlation analyses to determine how these constructs related to each other. We also conducted a regression analysis to examine if the two dimensions of hope, proactive personality, adaptive coping, and maladaptive coping predicted veterans' satisfaction with life. Lastly, we utilized a mediation analysis to investigate whether two coping styles mediated the relationships among personal resources and satisfaction with life. Findings from the regression analysis suggested hope pathways and proactive personality were significant predictors of satisfaction with life. Results from the mediation analysis suggested that adaptive and maladaptive coping did not mediate the relationships among personal resources and satisfaction with life.

Practitioner Review: It's time to bridge the gap - understanding the unmet needs of consumers with attention-deficit/hyperactivity disorder - a systematic review and recommendations

OBJECTIVE

Understanding the unmet needs of healthcare consumers with attention-deficit/hyperactivity disorder (ADHD) (individuals with ADHD and their caregivers) provides critical insight into gaps in services, education and research that require focus and funding to improve outcomes. This review examines the unmet needs of ADHD consumers from a consumer perspective.

METHODS

A standardised search protocol identified peer-reviewed studies published between December 2011 and December 2021 focusing on consumer-identified needs relating to ADHD clinical care or research priorities.

RESULTS

1,624 articles were screened with 23 studies that reviewed examining the needs of ADHD consumers from Europe, the U.K., Hong Kong, Iran, Australia, the U.S.A. and Canada. Consumer-identified needs related to: treatment that goes beyond medication (12 studies); improved ADHD-related education/training (17 studies); improved access to clinical services, carer support and financial assistance (14 studies); school accommodations/support (6 studies); and ongoing treatment efficacy research (1 study).

CONCLUSION

ADHD consumers have substantial unmet needs in clinical, psychosocial and research contexts. Recommendations to address these needs include: improving access to and quality of multimodal care provision; incorporating recovery principles into care provision; fostering ADHD health literacy; and increasing consumer participation in research, service development and ADHD-related training/education.

Does Hope Reverberate Between Generations?

Intergenerational transmission refers to the transmission of stories, traits, abilities, ideas, behaviors, and various outcomes from parents to their children. To date, there has been little research on the intergenerational transmission of positive behavior, traits, and actions. To determine whether hope may be transmitted from one generation to the next, a qualitative study was performed, using narrative inquiry and thematic analysis. Over 4 months, four mothers of children with mental illness were engaged in repeated conversations about stories of hope related to their past and how they envisioned hope in their children. Findings indicated that hope could be transmitted to the next generation, either explicitly (verbally) or implicitly (i.e., expressed through actions involving one's children). We conclude that also positive patterns may be transmitted both explicitly and implicitly from one generation to the next. Transmitting hope between generations played a significant role in the mothers' experiences of hope.

Toward Diabetes Device Development That Is Mindful to the Needs of Young People Living With Type 1 Diabetes: A Data- and Theory-Driven Qualitative Study

BACKGROUND

An important strategy to understand young people's needs regarding technologies for type 1 diabetes mellitus (T1DM) management is to examine their day-to-day experiences with these technologies.

OBJECTIVE

This study aimed to examine young people's and their caregivers' experiences with diabetes technologies in an exploratory way and relate the findings to the existing technology acceptance and technology design theories. On the basis of this procedure, we aimed to develop device characteristics that meet young people's needs.

METHODS

Overall, 16 in-person and web-based face-to-face interviews were conducted with 7 female and 9 male young people with T1DM (aged between 12 and 17 years) and their parents between December 2019 and July 2020. The participants were recruited through a pediatric diabetes clinic based at Canberra Hospital. Data-driven thematic analysis was performed before theory-driven analysis to incorporate empirical data results into the unified theory of acceptance and use of technology (UTAUT) and value-sensitive design (VSD). We used the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist for reporting our research procedure and findings. In this paper, we summarize the key device characteristics that meet young people's needs.

RESULTS

Summarized interview themes from the data-driven analysis included aspects of self-management, device use, technological characteristics, and feelings associated with device types. In the subsequent theory-driven analysis, the interview themes aligned with all UTAUT and VSD factors except for one (privacy). Privacy concerns or related aspects were not reported throughout the interviews, and none of the participants made any mention of data privacy. Discussions around ideal device characteristics focused on reliability, flexibility, and automated closed loop systems that enable young people with T1DM to lead an independent life and alleviate parental anxiety. However, in line with a previous systematic review by Brew-Sam et al, the analysis showed that reality deviated from these expectations, with inaccuracy problems reported in continuous glucose monitoring devices and technical failures occurring in both continuous glucose monitoring devices and insulin pumps.

CONCLUSIONS

Our research highlights the benefits of the transdisciplinary use of exploratory and theory-informed methods for designing improved technologies. Technologies for diabetes self-management require continual advancement to meet the needs and expectations of young people with T1DM and their caregivers. The UTAUT and VSD approaches were found useful as a combined foundation for structuring the findings of our study.

Efficacy of a multimodal lifestyle intervention (The Lift Project) for improving the mental health of individuals with an affective mood disorder living in South Africa

Background

Affective disorders are becoming more pervasive worldwide, including in Southern Africa, where treating patients with these conditions is challenging due to social and financial constraints. A variety of non-pharmacological approaches including lifestyle medicine (e.g., exercise, nutrition, sleep) and positive psychology practices (e.g., gratitude, service), are effective for treating mental health (MH) conditions.

Methods

Twenty-six individuals from South Africa with a diagnosed MH condition participated in a 10-week multimodal intervention incorporating a diverse range of non-pharmacological strategies for improving MH. MH metrics were assessed pre-and post-intervention, including general MH, vitality/energy (VIT), depression, anxiety, stress, and satisfaction with life. MH and VIT were also measured weekly.

Results

Improvements were observed in all mental metrics from pre-to post-intervention: MH (59%, p < 0.001, Cohen's D = 1.36), VIT (110%, p < 0.001, Cohen's D = 1.71), depression (-46%, p < 0.001, Cohen's D = -1.06), anxiety (-48%, p < 0.001, Cohen's D = -1.21), stress (-36%, p < 0.001, Cohen's D = -1.08) and life satisfaction (23%, p < 0.001, Cohen's D = 0.66). Significant improvements in MH and VIT were observed after only 1 week of the intervention and progressively increased until the seventh week, after which further improvements were not statistically significant.

Conclusion

The findings of this cohort study indicate that a multimodal intervention that incorporates lifestyle and positive psychology practices may benefit individuals living with an affective disorder. Non-pharmacological, multimodal interventions might offer a stigma-free way of providing MH promotion and treatment at a population level.

Adaptation and validation of the Adult Dispositional Hope Scale in the Ecuadorian context

This study aimed to evidence the validity and reliability of the Ecuadorian version of the Adult Dispositional Hope Scale, one of the most studied concepts of positive psychology. The adaptation process included translation and semantic and idiomatic validation. For content validation, an expert review and focus group were conducted. The questionnaire was applied to 2423 workers in Ecuador with a mean age of 37 years (SD = 9.04), and 65.6% were women. A confirmatory factor analysis was conducted to assess the validity of the scale's dimensionality. The reliability and convergent and discriminant validity were also evaluated. In order to investigate the best solution for an Ecuadorian version of the Adult Dispositional Hope Scale, four structural models were assessed. The unidimensional solution was the most adequate structure for the scale. The internal consistency of the scale was adequate. The Adult Dispositional Hope Scale (ADHS) was developed to assess this positive psychological state and has been the most used tool in many contexts. To our knowledge, this study is the first to adapt the Adult Dispositional Hope Scale into the Ecuadorian context and evaluate its validity. The findings support its reliability, factorial, and construct validity in the Ecuadorian context. Furthermore, the results show that dispositional hope acts as a protective factor, promoting work engagement and preventing burnout.

How do Mental Health Services Foster Hope? Experience of People Accessing Services

Hope is essential to mental health recovery, yet little is known about how mental health services can foster hope. This paper addresses the question: How can mental health services influence the sense of hope experienced by people who access their services? Sixty-one people who accessed a new mental health service were interviewed about their experiences, including about how the service had influenced their sense of hope. Interviews were analysed using constant comparative analysis. The data revealed that hope increased when people perceived positive changes in themselves and their circumstances: developing new understandings and perspectives; having effective strategies to manage challenges; seeing progress or having plans; and having support. Changes were attributed to three major features of the service: accessibility; staff competence and wisdom; and caring interactions. The findings highlight that, while individual clinicians are important, other interactions with services and the wider service context are also critical for facilitating hope.

Do recovery-oriented messages improve self-efficacy and positive emotions amongst people with lived experience of psychosis? Experimental investigation

OBJECTIVES

Recovery-oriented perspectives have become accepted worldwide as an alternative to the biomedical approach to conceptualizing and managing severe mental health problems. It has been proposed that one advantage of this is to support self-efficacy amongst people with a lived experience of psychosis, especially when recovery messages are presented by lived experience peers. The aim of the present study was to investigate the proposed psychological benefits of the recovery paradigm, by testing for possible differential impacts of recovery versus biomedical messages on self-efficacy beliefs and positive emotional state amongst people with experience of psychosis. It was hypothesized that (1) recovery-oriented messages, when presented by lived experience peers, would generate improvements in self-efficacy and positive emotions relative to biomedical messages presented by a professional and (2) recovery-oriented messages delivered by a professional would generate improvements in self-efficacy and positive emotions relative to biomedical messages delivered by a professional. We also explored whether recovery-oriented messages were more impactful when delivered by a lived experience peer versus a professional.

DESIGN

Experimental design with three within-subject video-based conditions.

METHODS

Fifty-three participants with lived experience of psychosis viewed three videos: (i) people with lived experience sharing their experiences of recovery; (ii) mental health professionals presenting traditional biomedical conceptualizations of psychosis; and (iii) mental health professionals presenting recovery perspectives. Participants provided baseline clinical and demographic information, and post-viewing ratings of experienced changes in self-efficacy and emotional state.

RESULTS

Hypothesis 1 was supported: both self-efficacy and positive emotions were significantly increased by a video of peers sharing personal recovery stories relative to professionals presenting biomedical messages. Hypothesis 2 was partially supported: when comparing videos of recovery versus biomedical messages delivered by professionals, significant relative benefits were found for positive emotions, but not self-efficacy.

CONCLUSIONS

This experimental investigation generated a pattern of findings broadly supportive of the assumed psychological benefits of the recovery paradigm for people with lived experiences of psychosis. Findings must be interpreted with caution given the limitations of the present design, but encourage further experimental research to directly test the interpersonal impacts of the recovery paradigm.

A Web-Based Positive Psychology App for Patients With Bipolar Disorder: Development Study

BACKGROUND

Patients with bipolar disorder (BD) report lower quality of life and lower levels of well-being than the general population. Despite the growing availability of psychotherapeutic and self-management interventions, important unmet needs remain. These unmet needs are closely linked to positive psychology domains. Although a growing number of studies have evaluated the impact of positive psychology interventions (PPIs) on patients with severe mental illness in general, only few have addressed the application of positive psychology for BD.

OBJECTIVE

This study aimed to gain insight into the opinions of patients with BD and health care professionals about (web-based) PPIs for BD and to develop and pilot-test an app containing PPIs specifically designed for patients with BD.

METHODS

The study was conducted in accordance with the Center for eHealth and Disease Management road map principles and incorporated cocreation and designing for implementation. Data were collected using focus group discussions, questionnaires, rapid prototyping, and web-based feedback on a prototype from the participants. In total, 3 focus groups were conducted with 62% (8/13) of patients with BD and 38% (5/13) of professionals. The collected data were used to develop a smartphone app containing short PPIs. The content was based on PPIs for which a solid base of evidence is available. Finally, a pilot test was conducted to test the app.

RESULTS

Focus groups revealed that PPIs as part of the current BD treatment can potentially meet the following needs: offering hope, increasing self-esteem, expressing feelings, acceptance, and preventing social isolation. Some patients expressed concern that PPIs may provoke a manic or hypomanic episode by increasing positive affect. The pilot of the app showed that the PPIs are moderately to highly valued by the participants. There were no adverse effects such as increase in manic or hypomanic symptoms.

CONCLUSIONS

With the systematic use of user involvement (patients and professionals) in all steps of the development process, we were able to create an app that can potentially fulfill some of the current unmet needs in the treatment of BD. We reached consensus among consumers and professionals about the potential benefits of PPIs to address the unmet needs of patients with BD. The use of PPI for BD is intriguing and can be usefully explored in further studies. We emphasize that more evaluation studies (quantitative and qualitative) that are focused on the effect of PPIs in the treatment of BD should be conducted. In addition, to establish the working mechanisms in BD, explorative, qualitative, designed studies are required to reveal whether PPIs can address unmet needs in BD.

The Role of Courtyards within Acute Mental Health Wards: Designing with Recovery in Mind

The role of courtyards and other outdoor spaces in the recovery of acute mental healthcare users has been gaining international appreciation and recognition. However, the physical properties and conditions necessary for therapeutic and rehabilitative engagement remain to be clearly established. This paper contributes to that knowledge by triangulating evidence from the literature, exemplar case studies of good practice and first-hand accounts of the experiences of staff and service users from four acute mental health facilities. The findings are then aligned with a well-established recovery framework (CHIMES) in light of existing landscape architecture knowledge. Within the complexity of varied mental health environments, this work establishes landscape architectural design requirements and qualities essential for recovery. Rather than adopting a prescriptive quantitative approach setting out areas, numbers of elements, etc., the proposed framework recommends a performance-based model and the creation of a cohesive network of microspaces that mesh into a design of outdoor areas. In this way, design details, materials, vegetation and the variety of spaces can be modified to suit service user population demographics and site-specific needs.

Psychosocial factors associated with dispositional hope, agency thinking, and pathways thinking in a homeless adult population

Adults facing homelessness often perceive themselves to be at the bottom of society, which has implications for their current and future well-being. Snyder's hope theory, which posits that agency thinking and pathways thinking are necessary for achieving a hopeful outlook on life, may be helpful for understanding drivers of well-being among individuals experiencing homelessness. In this study, we examined dispositional hope, perceived goal attainment, social support, and perceived standing in society among 123 adults experiencing homelessness who were attending a support group at a daytime drop-in center in the United States. Participants completed self-report measures related to the aforementioned variables of interest. We discovered that higher levels of self-reported goal attainment, independent of the type of goal identified, were significantly associated with total hope and both its subscales, that social support was significantly associated with total hope and pathways thinking, and that perceived standing in society was significantly associated with total hope and agency thinking.

Translating mental health recovery guidelines into recovery-oriented innovations: A strategy combining implementation teams and a facilitated planning process

Recovery is the focus of mental health strategies internationally. However, little translation of recovery knowledge has occurred in mental health services. The purpose of this research is to bridge the gap between recovery guidelines and practice by developing a new implementation strategy involving the formation of implementation teams made up of different stakeholders (service users, service providers, managers, knowledge users) and facilitating a 12-meeting implementation planning process. Sevenmental health organizations across Canada successfully completed the process of translating the guidelines into a recovery-oriented innovation that was implemented. Fifty-five implementation team members were interviewed upon completion of the 12-meeting process. Findings indicate that implementation team members perceived the structured planning process as positive. Nevertheless, the language of implementation science remains difficult to understand for a non-academic audience. Key elements of the 12-meeting process included the value of consensus building among implementation team members and the subsequent shifting power relationships. While working with diverse stakeholders came with certain challenges, the process in itself was a form of system transformation. This type of engaged planning process was a significant departure from the more top-down approaches to organizational change that staff were used to.

Mental Health Peer Worker Perspectives on Resources Developed from Lived Experience Research Findings: A Delphi Study

Lived experience research is potentially useful for assisting the recovery journeys of people experiencing mental health challenges, when presented in user-friendly formats. Consumer peer workers are ideally placed to introduce such resources to the people they work with. This study sought to explore the perspectives of expert consumer peer workers on the potential use of lived experience research resources in peer work practice. In particular: (1) what research topics would be most useful; and (2) what considerations are important for developing user-friendly and useful resources using findings from this research. A hybrid Delphi study was conducted. Eighteen expert peer workers participated in online group interviews, which included a semi-structured discussion and modified nominal group technique. These were followed by two rounds of surveys, which focused on prioritising the identified topics. Participants identified 47 topics suitable for lived experience research resources, 42 of which reached consensus as useful for consumers. A priority list of topics for use in peer work was identified through examination and grouping of peer worker rankings of the usefulness of resources for their work with consumers. The highest priority topics were as follows: developing and maintaining social networks; how peer workers can support consumers in their recovery journey; having choice with medications and participating in the decision-making process; and knowing your rights and responsibilities. Participants noted, however, that the usefulness of each topic ultimately depended on individual consumer's needs. They highlighted that a variety of formats and presentation were required to reach diverse consumer groups.

The perspective of staff members of two forensic psychiatric clinics in German-speaking Switzerland on the introduction of recovery orientation: An explorative study

Recovery orientation (RO) is directed at living a worthwhile life despite being impaired by the constraints of mental illness. Although being quite common in general psychiatry in Switzerland, the dual mission of forensic psychiatry-safeguarding and therapy-challenges the idea of establishing RO as a work philosophy in this context. This explorative study qualitatively investigates baseline expectations and professional perspectives of forensic staff members concerning the idea of establishing RO in Swiss forensic psychiatric wards. Thereby, three central themes were worked out, namely "challenges associated with recovery," "expected barriers," and "possible recovery-oriented interventions." From a general point of view, the staff members were uncertain whether RO interventions could be introduced at all, and if so, to what extent. This, on the one hand, had to do with structural obstacles such as security requirements; however, personal obstacles in the form of different, sometimes contradictory attitudesand ideals and fearful anticipations-such as the loss of authority and power-also played a central role. As forensic psychiatric wards are non-existent in Latin-speaking Switzerland, the study does only refer to the German-speaking language region.

An Emerging Preventive Mental Health Care Strategy: The Neurobiological and Functional Basis of Positive Psychological Traits

Even with the expanding burden of the COVID-19 pandemic on mental health, our approach to mental health care remains largely reactive rather than preventive. This trend is problematic because the majority of outpatient visits to primary care providers across the country is related to unmet mental health needs. Positive psychology has the potential to address these issues within mental health care and provide primary care providers with strategies to serve their patients more effectively. Positive psychology has many frameworks like hope, which can be measured using simple questionnaires in the waiting room. Moreover, there is a growing body of neurobiological evidence that lends credence to positive psychology concepts in the context of differential neuronal activation patterns. Many positive psychological instruments not only have high construct validity but also have connections to observable neurobiological differences tied to differences in psychosocial functioning. Despite the current evidence, we still need robust research that explores if such psychometric measurements and related interventions lead to clinically significant and favorable health outcomes in patients outside of controlled environments.

A Systematic Review and Lived-Experience Panel Analysis of Hopefulness in Youth Depression Treatment

Hopefulness is arguably of central importance to the recovery of youth with major or complex youth depression, yet it is unclear how hopefulness can best be enhanced in treatment. A narrative synthesis of published and grey literature was combined with new insights from a youth lived-experience panel (N = 15), focusing on to what extent and how specific psychological therapies and standard mental health care scaffold hopefulness as applied to depression among 14-25-year-olds. Thirty-one studies of variable quality were included in this review; thirteen were qualitative, thirteen quantitative, and five used mixed methods. Hopefulness is an important active ingredient of psychotherapies and standard mental health care in youth depression. Evidence suggests talking and activity therapies have moderate to large effects on hopefulness and that hopefulness can be enhanced in standard mental health care. However, varying intervention effects suggest a marked degree of uncertainty. Hopefulness is best scaffolded by a positive relational environment in which there is support for identifying and pursuing personally valued goals and engaging in meaningful activity. Animated (https://www.youtube.com/watch?v=o4690PdTGec) and graphical summaries (https://doi.org/10.13140/RG.2.2.27024.84487) are available.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40894-021-00167-0.

Initial Training for Mental Health Peer Support Workers: Systematized Review and International Delphi Consultation

BACKGROUND

Initial training is essential for the mental health peer support worker (PSW) role. Training needs to incorporate recent advances in digital peer support and the increase of peer support work roles internationally. There is a lack of evidence on training topics that are important for initial peer support work training and on which training topics can be provided on the internet.

OBJECTIVE

The objective of this study is to establish consensus levels about the content of initial training for mental health PSWs and the extent to which each identified topic can be delivered over the internet.

METHODS

A systematized review was conducted to identify a preliminary list of training topics from existing training manuals. Three rounds of Delphi consultation were then conducted to establish the importance and web-based deliverability of each topic. In round 1, participants were asked to rate the training topics for importance, and the topic list was refined. In rounds 2 and 3, participants were asked to rate each topic for importance and the extent to which they could be delivered over the internet.

RESULTS

The systematized review identified 32 training manuals from 14 countries: Argentina, Australia, Brazil, Canada, Chile, Germany, Ireland, the Netherlands, Norway, Scotland, Sweden, Uganda, the United Kingdom, and the United States. These were synthesized to develop a preliminary list of 18 topics. The Delphi consultation involved 110 participants (49 PSWs, 36 managers, and 25 researchers) from 21 countries (14 high-income, 5 middle-income, and 2 low-income countries). After the Delphi consultation (round 1: n=110; round 2: n=89; and round 3: n=82), 20 training topics (18 universal and 2 context-specific) were identified. There was a strong consensus about the importance of five topics: lived experience as an asset, ethics, PSW well-being, and PSW role focus on recovery and communication, with a moderate consensus for all other topics apart from the knowledge of mental health. There was no clear pattern of differences among PSW, manager, and researcher ratings of importance or between responses from participants in countries with different resource levels. All training topics were identified with a strong consensus as being deliverable through blended web-based and face-to-face training (rating 1) or fully deliverable on the internet with moderation (rating 2), with none identified as only deliverable through face-to-face teaching (rating 0) or deliverable fully on the web as a stand-alone course without moderation (rating 3).

CONCLUSIONS

The 20 training topics identified can be recommended for inclusion in the curriculum of initial training programs for PSWs. Further research on web-based delivery of initial training is needed to understand the role of web-based moderation and whether web-based training better prepares recipients to deliver web-based peer support.

User Involvement in the Handover between Mental Health Hospitals and Community Mental Health: A Critical Discourse Analysis

INTRODUCTION

This study aimed to explore how healthcare professionals and users could perceive user involvement in the handover between mental health hospitals and community mental healthcare, drawing on the discourse analysis framework from Fairclough.

METHODS

A qualitative research design with purposive sampling was adopted. Five audio-recorded focus group interviews with nurses, users and other health professionals were explored using Fairclough's discourse analysis framework. Ethical approval: The study was designed following the ethical principles of the Helsinki Declaration and Danish Law. Each study participant in the two intersectoral sectors gave their informed consent after verbal and written information was provided.

RESULTS

This study has shown how users can be subject to paternalistic control despite the official aims that user involvement should be an integral part of the care and treatment offered. As evidenced in discussions by both health professionals and the users themselves, the users were involved in plans with the handover on conditions determined by the health professionals who were predominantly focused on treating diseases and enabling the users to live a life independent of professional help.

CONCLUSIONS

Our results can contribute to dealing with the challenges of incorporating user involvement as an ideology in the handover between mental health hospitals and community mental health. There is a need to start forming a common language across sectors and, jointly, for professionals and users to draw up plans for intersectoral care.

The Importance of Belonging to a Context: A Nurse-Led Lifestyle Intervention for Adult Persons with ADHD

Living with attention deficit hyperactivity disorder (ADHD) and mental illness involves an increased risk of lifestyle-related diseases. Although there are several ways to provide support to adult persons with ADHD, there is a lack of non-medical strategies for this purpose. This study explore how adult persons with ADHD with mental illness experienced taking part in a nurse-led lifestyle intervention. Fifteen participants participated in a 52-week lifestyle intervention. The analysis revealed two main categories; Building trusting relationships and Health together. This nurse-led lifestyle intervention could be an alternative or complement to current approaches to promoting health in adults with ADHD.

Care Managers and Role Ambiguity: The Challenges of Supporting the Mental Health Needs of Patients with Chronic Conditions

As U.S. healthcare organizations transition to value-based healthcare, they are increasingly focusing on supporting patients who have difficulties managing chronic care, including mental health, through the growing role of care managers (CMs). CMs communicate with patients, provide access to resources, and coach them toward healthy behaviors. CMs also coordinate patient-related issues internally with healthcare practitioners and externally with community organizations and insurance providers. While there have been many interaction design studies regarding the work of clinical and non-clinical healthcare providers and how best to design support systems for them, we know little about the work of CMs. In this study, we examine the role of CMs, particularly focusing on their work to support patient mental health, through interviews with 11 CMs who are part of a large Midwestern U.S. health system. Workflow observations were conducted to supplement the interview data. We describe the role of CMs and identify challenges that they face in supporting patient mental health. A key challenge is a high degree of role ambiguity in this professional role. We discuss sociotechnical implications to better support care delivery processes and technologies for the delivery of mental health services by CMs.

The Potential Protective Effect of Hope on Students' Experience of Perceived Stress and Burnout during Medical School

BACKGROUND

A major problem facing today's physicians and medical students is burnout. Christina Maslach and fellow researchers have described burnout as a product of chronic stress and a lack of protective psychological factors like hope. The purpose of this study was to explore the relationships between hope, stress, and burnout among medical students.

METHODS

This study involved an online survey of 329 first- through fourth-year allopathic and osteopathic medical students. Validated psychometric scales were used to measure the primary variables. We conducted Pearson correlation, hierarchical regression, and mediation analyses to test the relationships between hope, stress, and burnout and to determine whether hope directly impacts stress and burnout.

RESULTS

We found significant correlations between hope, stress, and burnout. Hierarchical regression revealed that hope accounted for significant variance in burnout over and above psychological stress and that stress and hope together accounted for 48% of this variance. We discovered that hope may be partially mediating the relationship between stress and burnout.

CONCLUSION

Hope may play a significant protective role in the stress-burnout relationship in the context of medical students: higher levels of hope are associated with lower levels of stress and burnout. Our study supports the idea of using hope-based interventions in medical student populations and investing more resources into this area of research.

Whole Health Action Management: A Randomized Controlled Trial of a Peer-Led Health Promotion Intervention

OBJECTIVE

Adults with serious mental illness have high rates of general medical comorbidity and encounter challenges in dealing with multiple health conditions. Chronic illness self-management programs may help them more effectively cope with comorbid illnesses, especially when instructors are certified peer specialists. This study assessed the longitudinal effectiveness of a peer-delivered health promotion program.

METHODS

Community mental health program clients in Georgia and Illinois with serious mental illness and health impairments were randomly assigned to receive either Whole Health Action Management (WHAM), a medical illness self-management program led by peer specialists, or care as usual, resulting in a sample of N=139 (WHAM N=68, control N=71). Assessments were conducted at study baseline and at 3 and 6 months. Generalized estimating equations were used to examine change over time in the primary outcome of patient activation and secondary outcomes of general health, hope, and employment.

RESULTS

Longitudinal analysis indicated that compared with control participants, WHAM participants demonstrated significantly greater improvement over time in patient activation for health care. Intervention participants also demonstrated greater improvement in their self-assessed general health, overall hopefulness, and paid employment. Reactions to the WHAM program were positive, with 97% reporting being very or somewhat satisfied, and almost two-thirds (63%) reporting that their health was better than before they joined the program.

CONCLUSIONS

The WHAM program improved patient activation, perceived general medical health, hopefulness, and likelihood of paid employment among people with serious mental illness and co-occurring medical conditions. Results suggest that peer-delivered health self-management education is effective and well received by participants.

Igniting and Maintaining Hope: The Voices of People Living with Mental Illness

The study objective was to identify the types of experiences that consumers identify as igniting and maintaining hope, and those most frequently reported. Data were collected through an anonymous online survey. Two open-ended questions elicited reflective personal accounts regarding hope-promoting experiences. Using an interpretive content analysis design, data were coded inductively using constant comparative analysis. Numbers of participants reporting each type of experience were calculated to identify patterns of hopeful experiences. Findings from 72 participants highlighted a diversity of hope-promoting experiences and sources. Fifteen experiences were identified, forming two broad categories: interactions and experiences involving others, and personal or internal experiences, insights and actions. Findings suggest that consumers play an active role in igniting and maintaining their own hope. Peer workers and health workers can support this by being cognizant of the quality of their interactions with consumers and by facilitating connections with others, particularly families, friends and peers.

Surviving the "silent epidemic": A qualitative exploration of the long-term journey after traumatic brain injury

Previous studies examining life after traumatic brain injury (TBI) have taken a predominantly short-term and quantitative perspective, with generally narrow focus, and have not specifically investigated changes in experience over time post-injury to gain a uniquely long-term perspective. This study therefore aimed to qualitatively explore the broad long-term experience of living for 10 years or more with TBI. Thirty participants completed semi-structured interviews investigating the impact of TBI on various life domains, the rehabilitation experience and support received, and overall perspectives of the long-term journey after TBI. Results demonstrated that: (a) although some participants reported full recovery, several experienced persistent physical, cognitive and emotional problems that impacted their independence, employment and interpersonal relationships; (b) early rehabilitation was very helpful, but some participants experienced difficulties accessing ongoing services; (c) family and social support were important to recovery; (d) most participants drew upon inner strength to find positives in their experience. These findings have identified factors that facilitate and impede long-term recovery from TBI, which may inform better support and care for injured individuals over the years after injury to improve their quality of life.

Pathways to Recovery among Homeless People with Mental Illness: Is Impulsiveness Getting in the Way?

OBJECTIVE

This study investigates the association between impulsiveness and six dimensions of recovery among homeless people with mental illness.

METHOD

The sample was composed of 418 participants of a randomized controlled trial of Housing First, a recovery-oriented program that provides immediate access to permanent housing. The reliable change index method was used to provide an estimate of the statistical and clinical significance of the change from baseline to 24 months (i.e., clinically meaningful improvement), on outcomes that pertain to recovery dimensions: psychiatric symptoms (clinical), physical health and substance use problems (physical), residential stability (functional), arrests (criminological), community integration (social), and hope and personal confidence (existential). We tested for the effect of impulsiveness, assessed with the Barratt Impulsiveness Scale-11, on clinically meaningful improvement on each specific outcome, adjusting for age, gender and intervention assignment, as both intervention arms were included in the analysis.

RESULTS

For every increase in total impulsiveness score by one standard deviation, the odds of experiencing clinically meaningful improvement decreased by 29% (OR = 0.71, 95% CI, 0.55 to 0.91) on the clinical dimension and by 53% (OR = 0.47, 95% CI, 0.32 to 0.68) on the existential dimension. However, changes in outcomes pertaining to physical, functional, criminological, and social dimensions were not significantly influenced by impulsiveness.

CONCLUSIONS

Findings highlight the importance of addressing impulsiveness in the context of recovery-oriented interventions for homeless people with mental illness. Further research may be required to improve interventions that are responsive to unique needs of impulsive individuals to support clinical and existential recovery.

Typology of modifications to peer support work for adults with mental health problems: systematic review

BACKGROUND

Peer support work roles are being implemented internationally, and increasingly in lower-resource settings. However, there is no framework to inform what types of modifications are needed to address local contextual and cultural aspects.

AIMS

To conduct a systematic review identifying a typology of modifications to peer support work for adults with mental health problems.

METHOD

We systematically reviewed the peer support literature following PRISMA guidelines for systematic reviews (registered on PROSPERO (International Prospective Register of Systematic Reviews) on 24 July 2018: CRD42018094832). All study designs were eligible and studies were selected according to the stated eligibility criteria and analysed with standardised critical appraisal tools. A narrative synthesis was conducted to identify types of, and rationales for modifications.

RESULTS

A total of 15 300 unique studies were identified, from which 39 studies were included with only one from a low-resource setting. Six types of modifications were identified: role expectations; initial training; type of contact; role extension; workplace support for peer support workers; and recruitment. Five rationales for modifications were identified: to provide best possible peer support; to best meet service user needs; to meet organisational needs, to maximise role clarity; and to address socioeconomic issues.

CONCLUSIONS

Peer support work is modified in both pre-planned and unplanned ways when implemented. Considering each identified modification as a candidate change will lead to a more systematic consideration of whether and how to modify peer support in different settings. Future evaluative research of modifiable versus non-modifiable components of peer support work is needed to understand the modifications needed for implementation among different mental health systems and cultural settings.

Positive Psychology and Hope as Lifestyle Medicine Modalities in the Therapeutic Encounter: A Narrative Review

The majority of deaths in the United States are attributable to lifestyle-associated chronic diseases. Therapeutic encounters must now routinely address lifestyle-related behavior changes and promote patients' active involvement in self-care and chronic disease management. Positive psychology has been recognized in the realm of lifestyle medicine for its potential applications in effecting patient behavior change. One notable framework within positive psychology that is well suited for facilitating specific behavior changes is hope theory, which can be used to elicit change talk and build agency among patients with chronic diseases. This review explores key literature in positive psychology and hope theory and its practical applications to direct patient care, which includes an illustrative case study. There are still many unexplored intersections of health-related variables and hope. The cognitive framework of hope theory lends itself well to a broad range of situations, including brief ambulatory encounters. Clinicians will be instrumental in increasing our understanding of how hope theory can be applied to the therapeutic encounter. There are simple and efficient ways to innovate in this area. Having information about a patient's hope has the potential to make empathic connections easier and create opportunities to ask specific questions to help patients overcome barriers.

Not the story you want? Assessing the fit of a conceptual framework characterising mental health recovery narratives

PURPOSE

Narratives of recovery have been central to the development of the recovery approach in mental health. However, there has been a lack of clarity around definitions. A recent conceptual framework characterised recovery narratives based on a systematic review and narrative synthesis of existing literature, but was based on a limited sample. The aims of this study were to assess the relevance of the framework to the narratives of more diverse populations, and to develop a refined typology intended to inform narrative-based research, practice and intervention development.

METHOD

77 narrative interviews were conducted with respondents from four under-researched mental health sub-populations across England. Deductive and inductive analysis was used to assess the relevance of the dimensions and types of the preliminary typology to the interview narratives.

RESULTS

Five or more dimensions were identifiable within 97% of narratives. The preliminary typology was refined to include new definitions and types. The typology was found not to be relevant to two narratives, whose narrators expressed a preference for non-verbal communication. These are presented as case studies to define the limits of the typology.

CONCLUSION

The refined typology, based on the largest study to date of recovery narratives, provides a defensible theoretical base for clinical and research use with a range of clinical populations. Implications for practice include ensuring a heterogeneous selection of narratives as resources to support recovery, and developing new approaches to supporting non-verbal narrative construction.

A systematic review of influences on implementation of peer support work for adults with mental health problems

PURPOSE

The evidence base for peer support work in mental health is established, yet implementation remains a challenge. The aim of this systematic review was to identify influences which facilitate or are barriers to implementation of mental health peer support work.

METHODS

Data sources comprised online databases (n = 11), journal table of contents (n = 2), conference proceedings (n = 18), peer support websites (n = 2), expert consultation (n = 38) and forward and backward citation tracking. Publications were included if they reported on implementation facilitators or barriers for formal face-to-face peer support work with adults with a mental health problem, and were available in English, French, German, Hebrew, Luganda, Spanish or Swahili. Data were analysed using narrative synthesis. A six-site international survey [Germany (2 sites), India, Israel, Tanzania, Uganda] using a measure based on the strongest influences was conducted. The review protocol was pre-registered (Prospero: CRD42018094838).

RESULTS

The search strategy identified 5813 publications, of which 53 were included. Fourteen implementation influences were identified, notably organisational culture (reported by 53% of papers), training (42%) and role definition (40%). Ratings on a measure using these influences demonstrated preliminary evidence for the convergent and discriminant validity of the identified influences.

CONCLUSION

The identified influences provide a guide to implementation of peer support. For services developing a peer support service, organisational culture including role support (training, role clarity, resourcing and access to a peer network) and staff attitudes need to be considered. The identified influences provide a theory base to prepare research sites for implementing peer support worker interventions.

The impact of mental health recovery narratives on recipients experiencing mental health problems: Qualitative analysis and change model

BACKGROUND

Mental health recovery narratives are stories of recovery from mental health problems. Narratives may impact in helpful and harmful ways on those who receive them. The objective of this paper is to develop a change model identifying the range of possible impacts and how they occur.

METHOD

Semi-structured interviews were conducted with adults with experience of mental health problems and recovery (n = 77). Participants were asked to share a mental health recovery narrative and to describe the impact of other people's recovery narratives on their own recovery. A change model was generated through iterative thematic analysis of transcripts.

RESULTS

Change is initiated when a recipient develops a connection to a narrator or to the events descripted in their narrative. Change is mediated by the recipient recognising experiences shared with the narrator, noticing the achievements or difficulties of the narrator, learning how recovery happens, or experiencing emotional release. Helpful outcomes of receiving recovery narratives are connectedness, validation, hope, empowerment, appreciation, reference shift and stigma reduction. Harmful outcomes are a sense of inadequacy, disconnection, pessimism and burden. Impact is positively moderated by the perceived authenticity of the narrative, and can be reduced if the recipient is experiencing a crisis.

CONCLUSIONS

Interventions that incorporate the use of recovery narratives, such as peer support, anti-stigma campaigns and bibliotherapy, can use the change model to maximise benefit and minimise harms from narratives. Interventions should incorporate a diverse range of narratives available through different mediums to enable a range of recipients to connect with and benefit from this material. Service providers using recovery narratives should preserve authenticity so as to maximise impact, for example by avoiding excessive editing.

Person-Centered Psychiatric Nursing Interventions in Acute Care Settings

The knowledge base and understanding regarding psychiatric nursing interventions in acute care settings has been limited. The purpose of this hermeneutic phenomenological study was to explore psychiatric nurses' experiences in providing nursing interventions to adult clients in acute care settings. Six expert psychiatric nurses were recruited through purposive, snowball sampling and participated in key informant interviews. Analysis of the data revealed the central theme of person-centered care (PCC), which involved developing and delivering PCC plans; determining goals; fostering empathy, support, and hope; listening in one-to-one interactions; providing person-centered teaching; and enhancing coping strategies.

Post-traumatic growth in mental health recovery: qualitative study of narratives

OBJECTIVES

Post-traumatic growth, defined as positive psychological change experienced as a result of the struggle with challenging life circumstances, is under-researched in people with mental health problems. The aim of this study was to develop a conceptual framework for post-traumatic growth in the context of recovery for people with psychosis and other severe mental health problems.

DESIGN

Qualitative thematic analysis of cross-sectional semi-structured interviews about personal experiences of mental health recovery.

SETTING

England.

PARTICIPANTS

Participants were adults aged over 18 and: (1) living with psychosis and not using mental health services (n=21); (2) using mental health services and from black and minority ethnic communities (n=21); (3) underserved, operationalised as lesbian, gay, bisexual and transgender community or complex needs or rural community (n=19); or (4) employed in peer roles using their lived experience with others (n=16). The 77 participants comprised 42 (55%) female and 44 (57%) white British.

RESULTS

Components of post-traumatic growth were present in 64 (83%) of recovery narratives. Six superordinate categories were identified, consistent with a view that post-traumatic growth involves learning about oneself (self-discovery) leading to a new sense of who one is (sense of self) and appreciation of life (life perspective). Observable positively valued changes comprise a greater focus on self-management (well-being) and more importance being attached to relationships (relationships) and spiritual or religious engagement (spirituality). Categories are non-ordered and individuals may start from any point in this process.

CONCLUSIONS

Post-traumatic growth is often part of mental health recovery. Changes are compatible with research about growth following trauma, but with more emphasis on self-discovery, integration of illness-related experiences and active self-management of well-being. Trauma-related growth may be a preferable term for participants who identify as having experienced trauma. Trauma-informed mental healthcare could use the six identified categories as a basis for new approaches to supporting recovery.

TRIAL REGISTRATION NUMBER

ISRCTN11152837.

Development and Evaluation of a Recovery College Fidelity Measure

OBJECTIVE

Recovery Colleges are widespread, with little empirical research on their key components. This study aimed to characterize key components of Recovery Colleges and to develop and evaluate a developmental checklist and a quantitative fidelity measure.

METHODS

Key components were identified through a systematized literature review, international expert consultation (n = 77), and semistructured interviews with Recovery College managers across England (n = 10). A checklist was developed and refined through semistructured interviews with Recovery College students, trainers, and managers (n = 44) in 3 sites. A fidelity measure was adapted from the checklist and evaluated with Recovery College managers (n = 39, 52%), clinicians providing psychoeducational courses (n = 11), and adult education lecturers (n = 10).

RESULTS

Twelve components were identified, comprising 7 nonmodifiable components (Valuing Equality, Learning, Tailored to the Student, Coproduction of the Recovery College, Social Connectedness, Community Focus, and Commitment to Recovery) and 5 modifiable components (Available to All, Location, Distinctiveness of Course Content, Strengths Based, and Progressive). The checklist has service user student, peer trainer, and manager versions. The fidelity measure meets scaling assumptions and demonstrates adequate internal consistency (0.72), test-retest reliability (0.60), content validity, and discriminant validity.

CONCLUSIONS

Coproduction and an orientation to adult learning should be the highest priority in developing Recovery Colleges. The creation of the first theory-based empirically evaluated developmental checklist and fidelity measure (both downloadable at researchintorecovery.com/recollect ) for Recovery Colleges will help service users understand what Recovery Colleges offer, will inform decision making by clinicians and commissioners about Recovery Colleges, and will enable formal evaluation of their impact on students.

[Hope in tragedy. When action gives meaning to a life]

The experience of illness causes disorientation, a loss of meaning, and a loss of freedom to act. In other words, the entire field of practical possibilities diminishes, resulting in action being viewed as something impossible. In this case, the question is the following: Can the nurse contribute to maintaining hope for a life that is rich in meaning, adjusted to the limits imposed by the patient’s illness? To explore the answer to this question, we propose a humanistic model of accompaniment that enables nurses to restore hope and power to persons in vulnerable situations. In examining the best-case and the worst-case scenarios that a vulnerable person could be faced with, the accompaniment method proposed places emphasis on the exploration of practical interventions that could foster the best-case scenario and reduce the risk and the consequences of the worst-case scenario. By working on certain pragmatic aspects, we find that life becomes meaningful according to the use we can make of it, taking into account what we can actually do.

Characteristics of mental health recovery narratives: Systematic review and narrative synthesis

BACKGROUND

Narratives of recovery from mental health distress have played a central role in the establishment of the recovery paradigm within mental health policy and practice. As use of recovery narratives increases within services, it is critical to understand how they have been characterised, and what may be missing from their characterisation thus far. The aim of this review was to synthesise published typologies in order to develop a conceptual framework characterising mental health recovery narratives.

METHOD

A systematic review was conducted of published literature on the characteristics of mental health recovery narratives. Narrative synthesis involved identifying characteristics and organising them into dimensions and types; and subgroup analysis based on study quality, narrator involvement in analysis, diagnosis of psychosis and experience of trauma. The synthesis was informed by consultation with a Lived Experience Advisory Panel and an academic panel. The review protocol was pre-registered (Prospero CRD42018090188).

RESULTS

8951 titles, 366 abstracts and 121 full-text articles published January 2000-July 2018 were screened, of which 45 studies analysing 629 recovery narratives were included. A conceptual framework of mental health recovery narratives was developed, comprising nine dimensions (Genre; Positioning; Emotional Tone; Relationship with Recovery; Trajectory; Use of Turning Points; Narrative Sequence; Protagonists; and Use of Metaphors), each containing between two and six types. Subgroup analysis indicated all dimensions were present across most subgroups, with Turning Points particularly evident in trauma-related studies.

CONCLUSIONS

Recovery narratives are diverse and multidimensional. They may be non-linear and reject coherence. To a greater extent than illness narratives, they incorporate social, political and rights aspects. Approaches to supporting development of recovery narratives should expand rather than reduce available choices. Research into the narratives of more diverse populations is needed. The review supports trauma-informed approaches, and highlights the need to understand and support post-traumatic growth for people experiencing mental health issues.

Stability and mutual prospective relationships of stereotyped beliefs about mental illness, hope and depressive symptoms among people with schizophrenia spectrum disorders

Internalized stigma, hope and depressive symptoms are important variables in the recovery process of people with schizophrenia spectrum disorders, but little is known about their stability or relationship among each other over time. This study aims to unravel the longitudinal stability and relationships of these variables. 99 participants were included in this prospective study assessing internalized stigma, hope and depressive symptoms at baseline, with a first follow-up after three months and a second follow-up after six months. Multilevel models examined if the variables changed over time and a correlation coefficient was conducted to show their relationship to each other. Hope stayed stable over time, whereas internalized stigma and depressive symptoms significantly decreased over the study period. The correlation coefficient showed that internalized stigma and depressive symptoms influenced each other moderately over time. Thus, while hope was a stable construct over time, internalized stigma and depressive symptoms changed significantly and were correlated to each other positively. This implies that participants may adjust to their chronic condition over time, and recovery focused interventions should target both psychological dimensions at the same time.

Mental health recovery, goal setting and working alliance in an Australian community-managed organisation

This article examines the relationships between goal setting and achievement, working alliance and recovery in an Australian mental health community-managed organisation. The study gathered data over a 14-month period after the introduction of routine outcome measures. Both goal achievement and the strength of the working alliance were shown to have a positive effect on the personal recovery of the clients in the study. Both working alliance and goal achievement are robustly supportive at whatever point a person is on in the recovery journey. The brief goals card used is a useful adjunct to other tools.

Recovery After Psychosis: Qualitative Study of Service User Experiences of Lived Experience Videos on a Recovery-Oriented Website

BACKGROUND

Digital interventions offer an innovative way to make the experiences of people living with mental illness available to others. As part of the Self-Management And Recovery Technology (SMART) research program on the use of digital resources in mental health services, an interactive website was developed including videos of people with lived experience of mental illness discussing their recovery. These peer videos were designed to be watched on a tablet device with a mental health worker, or independently.

OBJECTIVE

Our aim was to explore how service users experienced viewing the lived experience videos on this interactive website, as well as its influence on their recovery journey.

METHODS

In total, 36 service users with experience of using the website participated in individual semistructured qualitative interviews. All participants had experience of psychosis. Data analysis occurred alongside data collection, following principles of constructivist grounded theory methodology.

RESULTS

According to participants, engaging with lived experience videos was a pivotal experience of using the website. Participants engaged with peers through choosing and watching the videos and reflecting on their own experience in discussions that opened up with a mental health worker. Benefits of seeing others talking about their experience included "being inspired," "knowing I'm not alone," and "believing recovery is possible." Experiences of watching the videos were influenced by the participants' intrapersonal context, particularly their ways of coping with life and use of technology. The interpersonal context of watching the videos with a worker, who guided website use and facilitated reflection, enriched the experience.

CONCLUSIONS

Engaging with lived experience videos was powerful for participants, contributing to their feeling connected and hopeful. Making websites with lived experience video content available to service users and mental health workers demonstrates strong potential to support service users' recovery.

The Relationship Between Clinical and Personal Recovery in Patients With Schizophrenia Spectrum Disorders: A Systematic Review and Meta-analysis

Patients describe experiencing personal recovery despite ongoing symptoms of psychosis. The aim of the current research was to perform a meta-analysis investigating the relationship between clinical and personal recovery in patients with schizophrenia spectrum disorders. A comprehensive OvidSP database search was performed to identify relevant studies. Correlation coefficients of the relationship between clinical and personal recovery were retrieved from primary studies. Meta-analyses were performed, calculating mean weighted effect sizes for the association between clinical and personal recovery, hope, and empowerment. Additionally, associations between positive, negative, affective symptoms, general functioning, and personal recovery were investigated. The results show that heterogeneity across studies was substantial. Random effect meta-analysis of the relationship between symptom severity and personal recovery revealed a mean weighted correlation coefficient of r = -.21 (95% CI = -0.27 to -0.14, P < .001). We found the following mean weighted effect size for positive symptoms r = -.20 (95% CI = -0.27 to -0.12, P < .001), negative symptoms r = -.24 (95% CI = -0.33 to -0.15, P < .001), affective symptoms r = -.34 (95% CI = -0.44 to -0.24, P < .001) and functioning r = .21 (95% CI = -0.09 to 0.32, P < .001). The results indicate a significant small to medium association between clinical and personal recovery. Psychotic symptoms show a smaller correlation than affective symptoms with personal recovery. These findings suggest that clinical and personal recovery should both be considered in treatment and outcome monitoring of patients with schizophrenia spectrum disorders.