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Nagashima I, Hayasaka T, Teruya K, Hoshino M, Murao M, Matumoto Y, Maruki T, Katagiri T, Imamura Y, Kurihara M, Oe Y, Tsuboi T, Watanabe K, Sakurai H. Factors encouraging participation in social activities after hospital discharge in people with severe mental illness who received occupational therapy. Front Psychiatry 2024; 15:1421390. [PMID: 39252758 PMCID: PMC11381417 DOI: 10.3389/fpsyt.2024.1421390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 08/13/2024] [Indexed: 09/11/2024] Open
Abstract
Introduction Occupational therapy (OT), a vital part of psychiatric rehabilitation, encourages participation in social activities, which is critical for the recovery of people with severe mental illnesses (SMI). However, the effects of OT on the subsequent social activities of patients with SMI have not been fully clarified. We aimed to identify the factors that encourage post-discharge social activity participation among patients with SMI who received OT. Method Patients who underwent OT at the Kyorin University Hospital between April 2016 and March 2020 were retrospectively examined for baseline data during hospitalization and social activity status 1 year after discharge. Occupational support, group adaptation, artistic activities, and exercise programs were considered. Activities requiring social interaction were defined as social activities, including employment, schooling, sheltered work, and volunteer work. Multiple logistic regression analyses using demographic and medical data, prehospitalization social activity status, and OT participation rates as independent variables were used to examine the factors encouraging social activity participation after discharge. Decision tree analysis was conducted to identify patients who specifically needed to increase OT participation. Results Of 524 eligible patients, 247 were included in the study. The number of patients who were socially active at admission and after discharge was 116 and 188, respectively. Multiple logistic regression analyses revealed that the following factors were likely to encourage social activity participation after discharge: higher rates of OT participation to facilitate group adaptation (OR = 1.015, 95% CI 1.003-1.027), being socially active at admission (OR = 4.557, 95% CI 2.155-9.637), and no marital history (OR = 0.293, 95% CI 0.130-0.661). Decision tree analysis showed that for patients who were socially inactive at admission and had a history of marriage, increasing OT participation to 52.6% or higher may ensure social activity participation after discharge. Conclusions This study identified patients whose social participation after discharge could be boosted by OT that facilitates group adaptation. Our findings would facilitate the development of individualized add-on rehabilitation based on the effects of real-world OT practices.
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Affiliation(s)
- Izumi Nagashima
- Department of Rehabilitation, Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | - Tomonari Hayasaka
- Department of Rehabilitation, Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | - Koji Teruya
- Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | | | - Masami Murao
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yasuyuki Matumoto
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Taku Maruki
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Takeshi Katagiri
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yayoi Imamura
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Mariko Kurihara
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yuki Oe
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hitoshi Sakurai
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
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Adamus C, Mötteli S, Jäger M, Richter D. Independent Supported Housing vs institutional housing rehabilitation settings for non-homeless individuals with severe mental illness - longitudinal results from an observational study. BMC Psychiatry 2024; 24:554. [PMID: 39123200 PMCID: PMC11312804 DOI: 10.1186/s12888-024-05995-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Most individuals with severe mental illness (SMI) strongly prefer independent living over living in an institution. Independent Supported Housing (ISH) provides housing rehabilitation for persons with SMI in their accommodations. However, most individuals who need housing rehabilitation live in institutional housing settings (housing rehabilitation as usual: HAU). We investigated which housing rehabilitation setting is effective on which variable in the long term to support service users to form an informed preference for either housing rehabilitation setting. METHODS We conducted a two-year longitudinal observational non-inferiority study to test the effectiveness of ISH in improving participants' social inclusion, quality of life, emotional social support, capabilities, symptom severity, functioning, service utilisation and costs. Participants were assessed at baseline and after six, twelve, and 24 months. Mixed effects models were computed to test between-group and within-group effects. RESULTS The study included 83 participants in ISH (n = 31) and HAU (n = 52) housing rehabilitation settings with a mean age of 36.2 years. Most participants were male (64%) and had a primary psychotic or schizophrenic (35%) or an affective diagnosis (24%). During the study, ISH participants significantly improved their quality of life (β = 0.54; 95% CI: 0.26 to 0.82), symptoms (β = -0.32; 95% CI: -0.60 to -0.03), and capabilities (β = 4.46; 95% CI: 0.14 to 8.77) and decreased psychiatric hospitalisations (p = 0.04). HAU participants improved their quality of life (β = 0.40; 95% CI: 0.12 to 0.69). Housing and rehabilitation support costs were almost half with ISH than with HAU. CONCLUSION ISH has been shown to be much less expensive than HAU and was associated with several improvements like reduced psychiatric hospitalisations and improved quality of life. Therefore, our findings strongly argue for a preference-driven provision of housing rehabilitation services and to end the institutionalisation of persons with SMI. TRIAL REGISTRATION The study was registered on December 04, 2018, at ClinicalTrials.gov (NCT03815604).
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Affiliation(s)
- Christine Adamus
- Center for Psychiatric Rehabilitation, Research and Development, Universitäre Psychiatrische Dienste Bern (UPD), Sägestrasse 75, CH-3098, Köniz, Switzerland.
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Sonja Mötteli
- Center for Psychiatric Rehabilitation, Research and Development, Universitäre Psychiatrische Dienste Bern (UPD), Sägestrasse 75, CH-3098, Köniz, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
- Psychiatrie Baselland, Liestal, Switzerland
| | - Dirk Richter
- Center for Psychiatric Rehabilitation, Research and Development, Universitäre Psychiatrische Dienste Bern (UPD), Sägestrasse 75, CH-3098, Köniz, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Laustsen LM, Ejlskov L, Chen D, Lasgaard M, Gradus JL, Østergaard SD, Grønkjær MS, Plana-Ripoll O. Interaction between mental disorders and social disconnectedness on mortality: a population-based cohort study. Br J Psychiatry 2024; 225:282-289. [PMID: 38708564 DOI: 10.1192/bjp.2024.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Despite the recognised importance of mental disorders and social disconnectedness for mortality, few studies have examined their co-occurrence. AIMS To examine the interaction between mental disorders and three distinct aspects of social disconnectedness on mortality, while taking into account sex, age and characteristics of the mental disorder. METHOD This cohort study included participants from the Danish National Health Survey in 2013 and 2017 who were followed until 2021. Survey data on social disconnectedness (loneliness, social isolation and low social support) were linked with register data on hospital-diagnosed mental disorders and mortality. Poisson regression was applied to estimate independent and joint associations with mortality, interaction contrasts and attributable proportions. RESULTS A total of 162 497 individuals were followed for 886 614 person-years, and 9047 individuals (5.6%) died during follow-up. Among men, interaction between mental disorders and loneliness, social isolation and low social support, respectively, accounted for 47% (95% CI: 21-74%), 24% (95% CI: -15 to 63%) and 61% (95% CI: 35-86%) of the excess mortality after adjustment for demographics, country of birth, somatic morbidity, educational level, income and wealth. In contrast, among women, no excess mortality could be attributed to interaction. No clear trends were identified according to age or characteristics of the mental disorder. CONCLUSIONS Mortality among men, but not women, with a co-occurring mental disorder and social disconnectedness was substantially elevated compared with what was expected. Awareness of elevated mortality rates among socially disconnected men with mental disorders could be of importance to qualify and guide prevention efforts in psychiatric services.
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Affiliation(s)
- Lisbeth Mølgaard Laustsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Linda Ejlskov
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Danni Chen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Lasgaard
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark; and Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Jaimie L Gradus
- Boston University School of Public Health, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marie Stjerne Grønkjær
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; and National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
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Wang S, Luo X, Zang X, Ma Y, Yang J. Impact of social reward on stress circuit function and regulation: Path differences between value affirmation and emotional support. Int J Clin Health Psychol 2024; 24:100499. [PMID: 39308781 PMCID: PMC11414685 DOI: 10.1016/j.ijchp.2024.100499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/19/2024] [Indexed: 09/25/2024] Open
Abstract
Background As two typical types of social rewards, both value affirmation and emotional support could alleviate acute stress response, but it is not clear whether they can impact stress circuit function and regulation through different neural pathways. Method Sixty-two participants were randomly assigned to the value affirmation, emotional support, and non-reward conditions, then administered an adapted version of the ScanSTRESS paradigm. Participants' subjective reports of uncontrollability and social evaluative threat were measured to explore the mitigation of stress by social rewards at the behavioral level. Meanwhile, their acute salivary cortisol response to stress was compared among different social reward conditions. Furthermore, we computed linear contrasts for performance (vs relaxation) and reward (vs non-reward) and used psychophysiological interaction (PPI) analysis to explore the impact of social reward on stress circuit function and regulation. Results Both value affirmation and emotional support conditions reduced subjective reports of uncontrollability and social evaluation threat, but not cortisol response to stress. Furthermore, value affirmation reduced uncontrollability by enhancing putamen activation, whereas emotional support reduced social evaluation threat by enhancing putamen activation. More importantly, during stress, value affirmation enhanced the functional connectivity of the putamen-hippocampus and putamen-angular gyrus (AG), whereas emotional support enhanced the functional connectivity of the putamen-ventrolateral prefrontal cortex (vlPFC) and putamen-temporal pole mid, compared to the non-reward condition. Conclusion Value affirmation and emotional support alleviated acute stress response in different neural pathways. These findings suggested a precise categorization of social reward in intervention of a range of adverse psychological and physiological responses caused by stress.
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Affiliation(s)
- Shuai Wang
- Faculty of Psychology, Southwest University, Chongqing 400715, China
- Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing 400715, China
| | - Xiao Luo
- Faculty of Psychology, Southwest University, Chongqing 400715, China
- Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing 400715, China
| | - Xinlei Zang
- Faculty of Psychology, Southwest University, Chongqing 400715, China
- Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing 400715, China
| | - Yiqing Ma
- Faculty of Psychology, Southwest University, Chongqing 400715, China
- Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing 400715, China
| | - Juan Yang
- Faculty of Psychology, Southwest University, Chongqing 400715, China
- Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing 400715, China
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Adamus C, Richter D, Sutor K, Zürcher SJ, Mötteli S. Preference for Competitive Employment in People with Mental Disorders: A Systematic Review and Meta-analysis of Proportions. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10192-0. [PMID: 38662329 DOI: 10.1007/s10926-024-10192-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE The inclusion of people with mental disorders (MD) into competitive employment has become an important political and therapeutic goal. The present paper investigates meta-analytically to which extent people with MD who were unemployed or on sick leave due to MD prefer to work in a competitive job environment. METHODS For this systematic review and meta-analysis of proportions, we searched Medline, PsycInfo, Cinahl, Google Scholar, and reference lists for peer-reviewed publications from 1990 to Dec 2023, which provided data on the job preferences of people with MD. Two authors independently conducted full-text screening and quality assessments. Pooled proportions of job preferences were calculated with a random-effects meta-analysis of single proportions, and subgroup analyses were performed to examine characteristics associated with job preferences. RESULTS We included 30 studies with a total of 11,029 participants in the meta-analysis. The overall proportion of participants who expressed a preference for competitive employment was 0.61 (95%-CI: 0.53-0.68; I2 = 99%). The subgroup analyses showed different preference proportions between world regions where the studies were conducted (p < 0.01), publication years (p = 0.03), and support settings (p = 0.03). CONCLUSION Most people with MD want to work competitively. More efforts should be given to preventive approaches such as support for job retention. Interventions should be initiated at the beginning of the psychiatric treatment when the motivation to work is still high, and barriers are lower. TRAIL REGISTRATION The protocol is published in the Open Science registry at https://osf.io/7dj9r.
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Affiliation(s)
- Christine Adamus
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), 3098, Köniz, Switzerland.
| | - Dirk Richter
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Kim Sutor
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Simeon Joel Zürcher
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sonja Mötteli
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Haugland SH, Topor A, Friesinger JG. 1 plus 1 is more than 2: mental health problems, financial difficulties, and social exclusion in a cross-sectional study of 28,047 general-population adults. BMC Public Health 2024; 24:1148. [PMID: 38658908 PMCID: PMC11044315 DOI: 10.1186/s12889-024-18555-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Mental health problems and financial difficulties each increase the risk of social exclusion. However, few large studies representing a broad age range have investigated the combined social effect of having both difficulties. The purpose of this cross-sectional study was to examine associations of mental health problems, financial difficulties, and the combination of both with social exclusion. METHODS This analysis was based on responses from 28,047 adults (age > 18 years) from the general population participating in The Norwegian Counties Public Health Survey 2019. Respondents answered questions about their financial situation, mental health problems, and social exclusion. Social exclusion was measured as a lack of social support, low participation in organized social activities, low participation in other activities, missing someone to be with, feeling excluded, and feeling isolated. Adjustments for sex and age were made in multivariable logistic regression analyses. RESULTS Having mental health problems or financial difficulties was associated with various measures of social exclusion (odds ratios [ORs] with 95% confidence intervals [CIs]: 1.33 [1.23-1.43] to 12.63 [10.90-14.64]). However, the odds of social exclusion strongly increased for respondents who reported a combination of mental health problems and financial difficulties compared with those who did not report either (ORs [CIs]: 2.08 [1.90-2.27] to 29.46 [25.32-34.27]). CONCLUSIONS Having the combination of mental health problems and financial difficulties is strongly associated with increased risk for social exclusion, far beyond the effect of either factor alone.
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Affiliation(s)
| | - Alain Topor
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
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Lin Y, Wei Q, Luo S, Ye X, Zheng F, Zheng L, Lu X, Li H, Wu S. The risk of suicidal intention in severe mental illness: An ecological perspective. Psychol Psychother 2023; 96:1044-1061. [PMID: 37668301 DOI: 10.1111/papt.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Guided by the ecosystem theory model framework, we aimed to explore the influence of three ecological dimensions (social, family and psychological factors) on suicidal intention in people with severe mental illness (SMI). We hypothesized that three factors influence suicidal intention, and that psychological factors may play a mediating role in the influence of social and family factors on suicidal intention. METHODS We collected 994 patients with SMI aged 18 and above from May 2021 to March 2022 in the Fourth Hospital of Fuzhou City. We used logistic regression to analyse the association between social, family, psychological factors and suicidal intention. Furthermore, we explored the mediating effects among the influencing factors. RESULTS Younger male patients with schizophrenia were more likely to have suicidal intention due to psychosocial family factors (p < .05). Social factors (poor interpersonal relations, social retreat, social activities outside the home), family factors (parental functions, activities within the family, family functions), psychological factors (anxiety, depression, interest in the outside world, overt aggression, lack of accountability and planning) were all independent risk factors for suicidal intention in patients. Mediation analysis showed anxiety and depression mediated the role of social and family factors on suicidal intention (p < .05). CONCLUSION Social, family and psychological factors were important risk factors for suicidal intention, with anxiety and depression being partial mediators for suicidal intention. Therefore, interventions that enhance family and social functioning and reduce anxiety and depression may be effective in reducing suicidal intention in SMI.
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Affiliation(s)
- Yawen Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Qinfei Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Suping Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaoying Ye
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Fuhao Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
- Department of Scientific Research Management, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Liuyan Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xinyue Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Huangyuan Li
- Department of Preventive Medicine, Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Siying Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
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Caple V, Maude P, Walter R, Ross A. An exploration of loneliness experienced by people living with mental illness and the impact on their recovery journey: An integrative review. J Psychiatr Ment Health Nurs 2023; 30:1170-1191. [PMID: 37382063 DOI: 10.1111/jpm.12945] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 05/15/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: There is evidence that social isolation and loneliness is more prevalent in people living with mental illness than in the general population. People living with mental illness frequently experience stigma, discrimination, rejection, repeated psychiatric admissions, low self-esteem, low self-efficacy, and increased symptoms of paranoia, depression, and anxiety. There is evidence of common interventions that can be used to improve loneliness and social isolation such as psychosocial skills training and cognitive group therapy. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper offers a comprehensive assessment of the evidence between mental illness, loneliness, and recovery. The results suggest that people living with mental illness experience elevated levels of social isolation and loneliness leading to poor recovery and quality of life. Social deprivation, social integration and romantic loneliness are related to loneliness, poor recovery, and reduced quality of life. A sense of belonging, ability to trust and hope are important aspects of improved loneliness, quality of life and recovery. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The existing culture in mental health nursing practice needs to be examined to address loneliness in people living with mental illness and its impact on recovery. Existing tools to research loneliness do not consider dimensions in loneliness experience as reflected in the literature. Practice needs to demonstrate an integrated approach to recovery, optimal service delivery and augmentation of evidence-based clinical practice to improve individual's loneliness, social circumstances, and relationships. Practice needs to demonstrate nursing knowledge in caring for people living with mental illness experiencing loneliness. Further longitudinal research is required to clearly understand the relationship between loneliness, mental illness, and recovery. ABSTRACT INTRODUCTION: To our knowledge, there are no previous reviews on the impact of loneliness experienced by people aged 18-65, who are living with mental illness and their recovery experience. AIM/QUESTION To explore the experience and impact of loneliness in people living with mental illness during recovery. METHOD An integrative review. RESULTS A total of 17 papers met the inclusion criteria. The search was conducted using four electronic databases: MEDLINE, CINAHL, Scopus and PsycINFO. Across these 17 papers, participants were most commonly, diagnosed with schizophrenia or psychotic disorders and recruited from community mental health services. DISCUSSION The review revealed loneliness to be substantial in people living with mental illness and that loneliness affected their recovery, and their quality of life. The review identified many factors that contribute to loneliness including unemployment, financial strain, social deprivation, group housing, internalized stigma and mental illness symptoms. Individual factors such as social/community integration and social network size as well as an inability to trust, a sense of not belonging, hopelessness and lack of romance were also evident. Interventions targeting social functioning skills and social connectedness were found to improve social isolation and loneliness. IMPLICATIONS FOR PRACTICE It is vital for mental health nursing practice to employ an approach integrating physical health as well as social recovery needs, optimal service delivery and augmentation of evidence-based clinical practice to improve loneliness, recovery, and quality of life.
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Affiliation(s)
- Vanessa Caple
- School of Nursing and Midwifery, La Trobe. University, Bundoora, Victoria, Australia
| | - Phil Maude
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, Latrobe University, Bendigo, Victoria, Australia
| | - Ruby Walter
- School of Health and Biomedical Sciences Nursing, RMIT University, Bundoora, Victoria, Australia
| | - Alistair Ross
- La Trobe Rural Health School, Latrobe University, Bendigo, Victoria, Australia
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DuPont-Reyes MJ, Villatoro AP, Datzman J, Phelan JC, Painter K, Barkin K, Link BG. Inequities Gone or Enduring? Evaluating the Effects of a School-Based Antistigma Intervention on Race/Ethnic and Gender Intersectional Disparities in Mental Illness Stigma. STIGMA AND HEALTH 2023; 8:381-392. [PMID: 37636031 PMCID: PMC10454522 DOI: 10.1037/sah0000406] [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: 08/29/2023]
Abstract
While significant mental illness stigma disparities across race/ethnicity and gender exist, little is known about the efficacy of anti-stigma interventions in reducing these intersectional disparities. We examine the two-year effects of school-based anti-stigma interventions on race/ethnic and gender intersectional stigma disparities among adolescents. An ethnically and socioeconomically diverse sixth grade sample (N = 302) self-completed surveys assessing stigma before randomly receiving an anti-stigma curriculum and/or contact intervention versus no intervention. Surveys were also self-completed two-years post-intervention. Stigma measures assessed general mental illness knowledge/attitudes, awareness/action, and social distance. Stigma towards peers with specific mental illnesses were examined using vignettes-two adolescent characters were described as having bipolar (Julia) and social anxiety (David) disorder. Race/ethnicity and gender were cross-classified into six intersectional groups (Latina/o, Non-Latina/o Black, and Non-Latina/o White girls and boys). Linear regressions adjusting for poverty and mental illness familiarity examined anti-stigma intervention effects across intersectional groups in sixth and eighth grade. The school-based anti-stigma intervention reduced intersectional stigma disparities over the two-year study period. While Non-Latino Black boys and Latino boys/girls reported greater disparities in stigma at baseline compared to Non-Latina White girls, these disparities (14 total) were predominantly eliminated in the two-year follow-up following receipt of the curriculum and contact components to just one remaining disparity post-intervention among Non-Latino Black boys. By identifying differences in how school-based anti-stigma interventions reduce mental illness stigma for unique race/ethnic and gender intersectional groups, we can better understand how to shape future anti-stigma interventions for diverse intersectional populations.
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Affiliation(s)
- Melissa J. DuPont-Reyes
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health
- Department of Epidemiology, Columbia University Mailman School of Public Health
| | | | - Jared Datzman
- Department of Epidemiology and Biostatistics, Texas A&M University
| | - Jo C. Phelan
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health
| | - Kris Painter
- School of Social Work, The University of Texas in Arlington
| | | | - Bruce G. Link
- School of Public Policy, University of California, Riverside
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Prell T, Stegmann S, Schönenberg A. Social exclusion in people with diabetes: cross-sectional and longitudinal results from the German Ageing Survey (DEAS). Sci Rep 2023; 13:7113. [PMID: 37130924 PMCID: PMC10152415 DOI: 10.1038/s41598-023-33884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/20/2023] [Indexed: 05/04/2023] Open
Abstract
As social exclusion can be linked to worse health and overall reduced quality of life, we describe social exclusion in people with diabetes and assess whether diabetes can be considered as a risk factor for social exclusion. We analyzed two waves (2014, 2017, N = 6604) from a survey of community-dwelling people aged > 40 using linear regression, group comparison and generalized estimating equations to explore the association between diabetes, social exclusion, socioeconomic, physical and psychosocial variables. In the entire cohort, diabetes was cross-sectionally associated with social exclusion after adjusting for covariates (p = 0.001). In people with diabetes, social exclusion was further associated with self-esteem (p < 0.001), loneliness (p = < 0.001), income (p = 0.017), depression (p = 0.001), physical diseases (p = 0.04), and network size (p = 0.043). Longitudinal data revealed that higher levels of social exclusion were already present before the diagnosis of diabetes, and future social exclusion was predicted by self-esteem, loneliness, depression, and income, but not by diabetes (p = .221). We conclude that diabetes is not a driver of social exclusion. Instead, both seem to co-occur as a consequence of health-related and psychosocial variables.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
| | | | - Aline Schönenberg
- Department of Geriatrics, Halle University Hospital, Halle, Germany.
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11
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Hu FH, Zhao DY, Fu XL, Zhang WQ, Tang W, Hu SQ, Shen WQ, Chen HL. Effects of social support on suicide-related behaviors in patients with severe mental illness: A systematic review and meta-analysis. J Affect Disord 2023; 328:324-333. [PMID: 36813042 DOI: 10.1016/j.jad.2023.02.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Patients with severe mental illness have a high risk of suicide and frequently living eliminated from mainstream society, but the effects of social support on suicide-related behaviors among this crowd is inconclusive. The present study aimed to explore such effects among patients with severe mental illness. METHODS We implemented a meta-analysis and a qualitative analysis of relevant studies published before February 6, 2023. Correlation coefficients (r) and 95 % CI were selected as the effect size index in meta-analysis. Studies that did not report correlation coefficients were employed for qualitative analysis. RESULTS Out of 4241 identified studies, 16 were identified in this review (6 for meta-analysis, 10 for qualitative analysis). The meta-analysis presented that the pooled correlation coefficients (r) were - 0.163 (95%CI = -0.243, -0.080, P < 0.001), suggesting a negative correlation between social support and suicidal ideation. The subgroup analysis showed that this effect works in all bipolar disorder, major depression, and schizophrenia. Concerning qualitative analysis, social support presented positive effects on reducing suicidal ideation, suicide attempts, and suicide death. The effects were consistently reported in female patients. However, there existed some unaffected results in males. LIMITATIONS The included studies were from middle- and high-income countries and used inconsistent measurement tools, our results may have some bias. CONCLUSIONS The effects of social support in reducing suicide-related behaviors were positive, but it showed better effects in both female patients and adults. Males and adolescents deserve more attention. Future research needs to pay more attention to the implementation methods and effects of personalized social support.
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Affiliation(s)
- Fei-Hong Hu
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Dan-Yan Zhao
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Xue-Lei Fu
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Wang-Qin Shen
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, PR China.
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12
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Fu XL, Qian Y, Jin XH, Yu HR, Wu H, Du L, Chen HL, Shi YQ. Suicide rates among people with serious mental illness: a systematic review and meta-analysis. Psychol Med 2023; 53:351-361. [PMID: 33952359 DOI: 10.1017/s0033291721001549] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND People with serious mental illness are at great risk of suicide, but little is known about the suicide rates among this population. We aimed to quantify the suicide rates among people with serious mental illness (bipolar disorder, major depression, or schizophrenia). METHODS PubMed and Web of Science were searched to identify studies published from 1 January 1975 to 10 December 2020. We assessed English-language studies for the suicide rates among people with serious mental illness. Random-effects meta-analysis was used. Changes in follow-up time and the suicide rates were presented by a locally weighted scatter-plot smoothing (LOESS) curve. Suicide rate ratio was estimated for assessments of difference in suicide rate by sex. RESULTS Of 5014 identified studies, 41 were included in this analysis. The pooled suicide rate was 312.8 per 100 000 person-years (95% CI 230.3-406.8). Europe was reported to have the highest pooled suicide rate of 335.2 per 100 000 person-years (95% CI 261.5-417.6). Major depression had the highest suicide rate of 534.3 per 100 000 person-years (95% CI 30.4-1448.7). There is a downward trend in suicide rate estimates over follow-up time. Excess risk of suicide in males was found [1.90 (95% CI 1.60-2.25)]. The most common suicide method was poisoning [21.9 per 100 000 person-years (95% CI 3.7-50.4)]. CONCLUSIONS The suicide rates among people with serious mental illness were high, highlighting the requirements for increasing psychological assessment and monitoring. Further study should focus on region and age differences in suicide among this population.
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Affiliation(s)
- Xue-Lei Fu
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Yan Qian
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Xiao-Hong Jin
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Hai-Rong Yu
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Hua Wu
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Lin Du
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, 226019 PR China
| | - Ya-Qin Shi
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
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13
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Job Retention and Reintegration in People with Mental Health Problems: A Descriptive Evaluation of Supported Employment Routine Programs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:128-136. [PMID: 36289141 PMCID: PMC9832069 DOI: 10.1007/s10488-022-01227-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/28/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Striking evidence supports the effectiveness of supported employment (SE) in achieving competitive employment in individuals with mental health problems. Yet, little is known whether SE is effective to maintain employment in individuals at risk of job loss. We aimed to descriptively compare SE for employed clients (SE-retention) and unemployed clients (SE-integration) regarding competitive employment. METHODS We used administrative data from January 2017 to October 2021 provided by a vocational rehabilitation center in Switzerland including all individuals (≥ 18yrs.) with mental health problems who participated either in SE-retention or SE-reintegration. The outcome was the proportion with competitive employment at discharge. Logistic regression was used to assess time trends and to descriptively compare SE-treatments. We used propensity score weighting, including personal, clinical and program-specific information to reduce group differences. RESULTS A total of 556 participants primarily diagnosed with mood/stress-related, schizophrenia and personality disorders were included (n = 297 SE-retention, n = 259 SE-reintegration) with median age 41 years and 57% female gender. The overall weighted comparison favored SE-retention over SE-reintegration OR 4.85 (95%-CI 3.10 to 7.58, p < 0.001) with predicted employment of 67.3% and 29.9% for SE-retention and SE-reintegration, respectively. While success for SE-reintegration remained stable over time, SE-retention showed an increase in more recent years. CONCLUSION SE-retention provides an approach for early work-related support that can prevent labor market exclusion. In contrast, reintegration is likely to require more efforts to achieve employment and may result in less favorable outcomes. It is therefore necessary that further research includes appropriate comparison groups to evaluate the effectiveness of SE-retention programs as well as the economic and individual benefits.
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14
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COVID-19 Vaccination Prioritization Strategies in Malaysia: A Retrospective Analysis of Early Evidence. Vaccines (Basel) 2022; 11:vaccines11010048. [PMID: 36679893 PMCID: PMC9861551 DOI: 10.3390/vaccines11010048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) that can cause extreme acute respiratory syndrome has posed a catastrophic threat to public health. The vaccines had indeed restored optimism and, after more than two years of battling the pandemic, there is renewed hope for the transition to endemicity. At the start of vaccination efforts, when supply shortages of vaccines were inevitable, every nation determined the high-risk population groups to be given priority for the COVID-19 vaccines. In this paper, the characteristics of the initial COVID-19 vaccine recipients in Malaysia are described. In line with the policies of many other countries, Malaysia firstly inoculated frontline healthcare workers, and subsequently the list of front liners grew to include defense and security personnel and those involved in the provision of essential services. People with disabilities or those with special needs and several underlying medical conditions that increased their risk of developing severe COVID-related illnesses were included in the priority categories. These included patients with severe lung disease, chronic heart disease, chronic kidney disease, chronic liver disease, neurological disease, diabetes mellitus and obesity in adults, splenic dysfunction, and severe mental illness. With little information and under circumstances of great uncertainty, the Health Ministry of a middle-income country had developed a vaccination priority-list based on the disease's epidemiology and clinical data, vaccine type, operational considerations, and risk evaluation. Early evidence was presented and suggested that the full vaccination with any of the three predominant vaccines (AZD1222, BNT162b2, and CoronaVac) in the country had been highly effective in preventing COVID-19 infections, COVID-19-related ICU admissions, and death. As many SARS-CoV-2 variants of concern (VoC), such as the Omicron BA.2/4/5, are emerging, future vaccination strategies may necessitate the need to change the immunogen of the vaccine, as well as considerations for when to give high-risk groups booster injections. These considerations are valuable for future planning by policymakers and healthcare providers to make vaccination policy and decisions, especially for the inclusion of the COVID-19 vaccines into national immunization programs.
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15
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Factors of Parental Preparation of Children with Mental Illnesses for Their Independent Living after Their Own Death. Healthcare (Basel) 2022; 10:healthcare10122360. [PMID: 36553884 PMCID: PMC9777822 DOI: 10.3390/healthcare10122360] [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: 10/26/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
Families of children with mental illnesses are often concerned about living in the community after their parents' death. The cross-sectional study aimed to examine the association between how parents prepare adult children with mental illnesses to live independently after the death of the parent(s). The participants were 1112 members of 46 family support groups for mental illnesses in Tokyo, Japan. The age of the people with mental illness was 40s, and that of their parents was 70s. Logistic regression analysis showed that mothers' support in daily living, no income or pension for disabled people, staying at home during free time, and parental livelihood being the same as the person with mental illness were factors that were negatively associated with the independent living of people with mental illness. In contrast, parental participation in the family group and creating a system for securing regular living expenses of the person with mental illness were positively associated with independent living. The results suggest that parents need to promote their children's recovery and prepare them financially by forecasting their independent living after their own death.
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16
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Cai H, Bai W, Du X, Zhang L, Zhang L, Li YC, Liu HZ, Tang YL, Jackson T, Cheung T, An FR, Xiang YT. COVID-19 vaccine acceptance and perceived stigma in patients with depression: a network perspective. Transl Psychiatry 2022; 12:429. [PMID: 36195590 PMCID: PMC9530420 DOI: 10.1038/s41398-022-02170-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/20/2022] Open
Abstract
The association between coronavirus disease (COVID-19) vaccine acceptance and perceived stigma of having a mental illness is not clear. This study examined the association between COVID-19 vaccine acceptance and perceived stigma among patients with recurrent depressive disorder (depression hereafter) using network analysis. Participants were 1149 depressed patients (842 men, 307 women) who completed survey measures of perceived stigma and COVID-19 vaccine attitudes. T-tests, chi-square tests, and Kruskal-Wallis tests were used to compare differences in demographic and clinical characteristics between depressed patients who indented to accepted vaccines and those who were hesitant. Hierarchical multiple regression analyses assessed the unique association between COVID-19 vaccine acceptance and perceived stigma, independent of depression severity. Network analysis examined item-level relations between COVID-19 vaccine acceptance and perceived stigma after controlling for depressive symptoms. Altogether, 617 depressed patients (53.7%, 95 confidence intervals (CI) %: 50.82-56.58%) reported they would accept future COVID-19 vaccination. Hierarchical multiple regression analyses indicated higher perceived stigma scores predicted lower levels of COVID-19 vaccination acceptance (β = -0.125, P < 0.001), even after controlling for depression severity. In the network model of COVID-19 vaccination acceptance and perceived stigma nodes, "Feel others avoid me because of my illness", "Feel useless", and "Feel less competent than I did before" were the most influential symptoms. Furthermore, "COVID-19 vaccination acceptance" had the strongest connections with illness stigma items reflecting social rejection or social isolation concerns ("Employers/co-workers have discriminated", "Treated with less respect than usual", "Sense of being unequal in my relationships with others"). Given that a substantial proportion of depressed patients reported hesitancy with accepting COVID-19 vaccines and experiences of mental illness stigma related to social rejection and social isolation, providers working with this group should provide interventions to reduce stigma concerns toward addressing reluctance in receiving COVID-19 vaccines.
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Affiliation(s)
- Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, Macao SAR, China
| | - Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, Macao SAR, China
| | - Xiangdong Du
- Guangji Hospital Affiliated to Soochow University, Suzhou, Jiangsu province, China
| | - Ling Zhang
- Nanning Fifth People's Hospital, Nanning, Guangxi province, China
| | - Lan Zhang
- Department of Psychiatry, Lanzhou University Second Hospital, Lanzhou, Gansu province, China
| | - Yu-Chen Li
- Department of Psychiatry, Xiamen Xianyue Hospital, Xiamen, China
| | - Huan-Zhong Liu
- Department of Psychiatry, Chaohu Hospital, Anhui Medical University, Hefei, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
- Atlanta VA Medical Center, Atlanta, GA, USA
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao, Macao SAR, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China.
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, Macao SAR, China.
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Roberts R, Johnson C, Hopwood M, Firth J, Jackson K, Sara G, Allan J, Calder R, Manger S. The Potential Impact of a Public Health Approach to Improving the Physical Health of People Living with Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11746. [PMID: 36142019 PMCID: PMC9516962 DOI: 10.3390/ijerph191811746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
With already wide disparities in physical health and life expectancy, COVID-19 presents people with mental illness with additional threats to their health: decreased access to health services, increased social isolation, and increased socio-economic disadvantage. Each of these factors has exacerbated the risk of poor health and early death for people with mental illness post-COVID-19. Unless effective primary care and preventative health responses are implemented, the physical illness epidemic for this group will increase post the COVID-19 pandemic. This perspective paper briefly reviews the literature on the impact of COVID-19 on service access, social isolation, and social disadvantage and their combined impact on physical health, particularly cancer, respiratory diseases, heart disease, smoking, and infectious diseases. The much-overlooked role of poor physical health on suicidality is also discussed. The potential impact of public health interventions is modelled based on Australian incidence data and current research on the percentage of early deaths of people living with mental illnesses that are preventable. Building on the lessons arising from services' response to COVID-19, such as the importance of ensuring access to preventive, screening, and primary care services, priority recommendations for consideration by public health practitioners and policymakers are presented.
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Affiliation(s)
- Russell Roberts
- Faculty of Business, Justice and Behavioural Science, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Caroline Johnson
- Melbourne Medical School, University of Melbourne, Parkville, VIC 3010, Australia
| | - Malcolm Hopwood
- Melbourne Medical School, University of Melbourne, Parkville, VIC 3010, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK
| | - Kate Jackson
- NSW Ministry of Health, St Leonards, NSW 2065, Australia
| | - Grant Sara
- NSW Ministry of Health, St Leonards, NSW 2065, Australia
- Sydney Medical School, Northern Clinical School, University of Sydney, Sydney, NSW 2001, Australia
| | - John Allan
- Queensland Health, University of Queensland, Brisbane, QLD 4072, Australia
| | - Rosemary Calder
- Mitchell Institute, Victoria University, Melbourne, VIC 3000, Australia
| | - Sam Manger
- College of Dentistry and Medicine, James Cook University, Townsville, QLD 4811, Australia
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18
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Smith P, Nicaise P, Lorant V. Social integration of people with non-psychotic mental illness over the last 2 decades: the widening gap in the adult population in Belgium. Soc Psychiatry Psychiatr Epidemiol 2022; 58:723-733. [PMID: 35606460 DOI: 10.1007/s00127-022-02302-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/05/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Social integration is poor among people with mental illness (MI). In recent decades, many countries have developed policies to address this issue. It remains unclear, however, whether their social integration has improved over time. This study aimed to assess the evolution of the social integration of adults with moderate and severe non-psychotic MI compared to the general population without MI between 1997 and 2018 in Belgium. METHODS Data on the general adult population were retrieved from the Belgian Health Interview Survey in six cross-sectional waves from 1997 to 2018. Three degrees of non-psychotic MI severity were compared using the 12-items General Health Questionnaire: no MI, moderate MI, and severe MI (score < 4, 4-7, and > 7). Social integration was measured using indicators relating to employment, income, social contacts, and partnership. RESULTS Since 1997, the probability of being unemployed, having limited social contacts, and living on less than 60% of the median national income has been increasing among people with severe non-psychotic MI. Between 1997 and 2018, social integration increased among the general population without MI and among people with moderate non-psychotic MI, but decreased among people with severe non-psychotic MI. CONCLUSION The gap between the social integration of people with severe non-psychotic MI and people with moderate or no MI has widened over time, despite major reforms of mental health care and policies. Policymakers and clinical practitioners should pay more attention to supporting the social integration of people with more severe MI, particularly in relation to employability and social support.
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Affiliation(s)
- Pierre Smith
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30, 1200, Brussels, Belgium. .,Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30, 1200, Brussels, Belgium
| | - Vincent Lorant
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30, 1200, Brussels, Belgium
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19
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Segeren M, Lauriks S, Kikkert M, Heering J, Lommerse N, van Husen G, Verhoeff A. Deinstitutionalization from the perspective of community-dwelling adults with a severe mental illness in Amsterdam: a cohort study protocol. BMC Public Health 2022; 22:950. [PMID: 35549681 PMCID: PMC9097409 DOI: 10.1186/s12889-022-13291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background People with a severe mental illness (SMI) increasingly receive ambulatory forms of care and support. The trend of deinstitutionalization accelerated in the Netherlands from 2008 and onwards without sufficient understanding of its consequences. The study protocol herein focuses on deinstitutionalization from the perspective of adults with an SMI living within the community in Amsterdam and aims at delivering better insight into, amongst others, their recovery, quality of life, societal participation and needs for care and support. Methods A cohort design will be used. A representative sample of community-dwelling adults with an SMI, including those in care (n = 650) and not in care (n = 150), will be followed over time. During a two-year time period, participants will be interviewed twice using a wide-ranging set of validated instruments. Interview data will be matched with administrative data about the care process, as retrieved from their patient files. Primary outcomes are changes over time in recovery, societal participation and quality of life, controlled for the occurrence of adverse life-events during follow-up. Additionally, prevalence estimates of and associations between social functioning, safety and discrimination, substance use and health indicators will be investigated. Discussion The study protocol aims at delivering a comprehensive insight into the needs of community-dwelling adults with an SMI based on which ambulatory care and support can best be provided to optimally promote their social recovery and well-being.
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Affiliation(s)
- Menno Segeren
- Public Health Service Amsterdam, Department of Epidemiology, Health Promotion and Care Innovation, Amsterdam, the Netherlands.
| | - Steve Lauriks
- Public Health Service Amsterdam, Department of Epidemiology, Health Promotion and Care Innovation, Amsterdam, the Netherlands
| | - Martijn Kikkert
- Department of Research, Arkin Mental Health Care Institute, Amsterdam, the Netherlands
| | - Jet Heering
- GGZ inGeest, Department of Research & Innovation, Amsterdam, the Netherlands
| | - Nick Lommerse
- Department of Research, Arkin Mental Health Care Institute, Amsterdam, the Netherlands
| | - Gwen van Husen
- Public Health Service Amsterdam, Department of Epidemiology, Health Promotion and Care Innovation, Amsterdam, the Netherlands
| | - Arnoud Verhoeff
- Public Health Service Amsterdam, Department of Epidemiology, Health Promotion and Care Innovation, Amsterdam, the Netherlands.,Department of Sociology, University of Amsterdam, Amsterdam, the Netherlands
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20
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Tzur Bitan D, Kridin K, Cohen AD, Weinstein O. COVID-19 hospitalisation, mortality, vaccination, and postvaccination trends among people with schizophrenia in Israel: a longitudinal cohort study. Lancet Psychiatry 2021; 8:901-908. [PMID: 34364406 PMCID: PMC8342316 DOI: 10.1016/s2215-0366(21)00256-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/21/2021] [Accepted: 07/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Individuals with schizophrenia have an increased risk of severe COVID-19 outcomes, nonetheless, no previous study has provided a year-long account of this risk, or assessed postvaccination trends in this population. This study assessed temporal trends in COVID-19 hospitalisation and mortality among people with schizophrenia during the first year of the pandemic, the predictors for COVID-19 vaccination, postvaccination infection, admission to hospital, and mortality. METHODS In this longitudinal cohort study, people with schizophrenia (n=25 539) and controls (n=25 539) were assessed for COVID-19 outcomes before and after vaccination, up to April 30, 2021. Cox proportional hazard regression models and Kaplan-Meier analyses were done to assess longitudinal trends. The study used the databases of Clalit Health Services, the largest health-care organisation in Israel. FINDINGS The sample included 51 078 participants, of which 31 141 (61·0%) male and 19 937 (39·0%) female participants, with a mean age of 51·94 years (SD 15·62). Most of the sample was from the general Jewish population (75·9%), followed by the Arab (19·1%) and Jewish Ultraorthodox population (5·1%). Overall of 51 078 individuals, 356 (0·7%) people had been hospitalised, 133 (0·3%) had died, and a total of 27 400 (53·6%) had been vaccinated. People with schizophrenia showed a higher risk for COVID-19 hospitalisation (HR 4·81, 95% CI 3·57-6·48, p<0·0001) and mortality (HR 2·52, 95% CI 1·64-3·85, p<0·0001), and showed a sharper decline in survival as time progressed. The control group showed a sharper incline in probability to vaccinate (log-rank=309·88, p<0·0001). Medical comorbidity of diabetes, hypertension, obesity, or ischaemic heart disease played a significant role in predicting vaccination rates in the schizophrenia group (all p<0·0001), but not in the control group. Hospitalisation and mortality disparities remained higher among people with schizophrenia who had not been vaccinated in comparison to controls (incidence rate difference of 6·2 and 3·2, respectively) but substantially declined in fully vaccinated groups (incidence rate difference of 1·1 and -0·9, respectively). INTERPRETATION People with schizophrenia have higher hospitalisation and mortality risk, yet have lower rates of vaccination than in the general population. Disparities in COVID-19 severe outcomes can be substantially reduced by national vaccination plans aimed at actively reaching out to people with schizophrenia. FUNDING No funding.
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Affiliation(s)
- Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel; Shalvata Mental Health Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Poria Medical Center, Poria, Israel
| | - Arnon Dov Cohen
- Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Orly Weinstein
- Hospital Division, Clalit Health Services, Tel Aviv, Israel; Department of Health Systems Administration, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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21
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Fortuna KL, Williams A, Mois G, Jason K, Bianco CL. Social Processes Associated With Health and Health Behaviors Linked to Early Mortality in People With a Diagnosis of a Serious Mental Illness. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 17:183-190. [PMID: 34264159 DOI: 10.1177/1745691621990613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individuals with serious mental illness (SMI) experience a 10- to 25-year reduced life expectancy compared with the general population. Early mortality for people with SMI has mainly been attributed to unhealthy behaviors (e.g., poor diet, sedentary lifestyle), which has led to the development of health promotion and self-management interventions specifically for people with SMI to promote health behavior change. Yet after decades of research, the mortality gap between people with SMI and the general population is increasing. To address this early mortality disparity for individuals with SMI, a new paradigm must be explored. In this article, we present the social processes impacting early mortality in people with SMI paradigm, which highlights the powerful role of social processes in shaping the health and health behaviors of people with SMI. This paradigm explores how loneliness, stigma (social and self), trauma, social exclusion, social isolation, and social norms are related to early mortality in people with SMI. This new paradigm is an important step in understanding and potentially addressing early mortality in people with SMI.
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Affiliation(s)
- Karen L Fortuna
- Dartmouth Centers for Health and Aging, Lebanon, New Hampshire
| | | | - George Mois
- School of Social Work, University of Georgia
| | - Kendra Jason
- Department of Sociology, University of North Carolina Charlotte
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22
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Mazereel V, Van Assche K, Detraux J, De Hert M. COVID-19 vaccination for people with severe mental illness: why, what, and how? Lancet Psychiatry 2021; 8:444-450. [PMID: 33548184 PMCID: PMC7906686 DOI: 10.1016/s2215-0366(20)30564-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022]
Abstract
Psychiatric disorders, and especially severe mental illness, are associated with an increased risk of severe acute respiratory syndrome coronavirus 2 infection and COVID-19-related morbidity and mortality. People with severe mental illness should therefore be prioritised in vaccine allocation strategies. Here, we discuss the risk for worse COVID-19 outcomes in this vulnerable group, the effect of severe mental illness and psychotropic medications on vaccination response, the attitudes of people with severe mental illness towards vaccination, and, the potential barriers to, and possible solutions for, an efficient vaccination programme in this population.
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Affiliation(s)
- Victor Mazereel
- Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium; Department of Neurosciences, and University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Kristof Van Assche
- Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium
| | - Johan Detraux
- Public Health Psychiatry, KU Leuven, Leuven, Belgium; Department of Neurosciences, and University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Marc De Hert
- Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium; Department of Neurosciences, and University Psychiatric Center, KU Leuven, Leuven, Belgium; Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium.
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23
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Yu YH, Luo W, Liu B, Kuang WH, Davidson L, Wan Chan CL, Lu L, Xiang MZ, Ran MS. Poverty transitions in severe mental illness: longitudinal analysis of social drift in China, 1994-2015. Psychol Med 2021; 52:1-9. [PMID: 33618792 DOI: 10.1017/s0033291721000350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although poverty associated with severe mental illness (SMI) has been documented in many studies, little long-term evidence of social drift exists. This study aimed to unravel the poverty transitions among persons with SMI in a fast change community in China. METHODS Two mental health surveys, using the International Classification of Disease (ICD-10), were conducted in the same six townships of Xinjin county, Chengdu, China in 1994 and 2015. A total of 308 persons with SMI identified in 1994 were followed up in 2015. The profiles of poverty transitions were identified and regression modelling methods were applied to determine the predictive factors of poverty transitions. RESULTS The poverty rate of persons with SMI increased from 39.9% to 49.4% in 1994 and 2015. A larger proportion of them had fallen into poverty (27.3%) rather than moved out of it (17.8%). Those persons with SMI who had lost work ability, had physical illness and more severe mental disabilities in 1994, as well as those who had experienced negative changes on these factors were more likely to live in persistent poverty or fall into poverty. Higher education level and medical treatment were major protective factors of falling into poverty. CONCLUSIONS This study shows long-term evidence on the social drift of persons with SMI during the period of rapid social development in China. Further targeted poverty alleviation interventions should be crucial for improving treatment and mental recovery and alleviating poverty related to SMI.
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Affiliation(s)
- Yue-Hui Yu
- School of Public Administration and Policy, Renmin University of China, Beijing100872, China
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, Xinjin, Chengdu611432, China
| | - Bo Liu
- Jingzhou Mental Health Center, Jingzhou, Hubei434000, China
| | - Wei-Hong Kuang
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu610041, China
| | | | - Cecilia Lai Wan Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Lin Lu
- Peking University Sixth Hospital, Institute of Mental Health, Peking University, Beijing100191, China
| | - Meng-Ze Xiang
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu610041, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
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24
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Pothier W, Lecomte T, Cellard C, Delfosse C, Fortier S, Corbière M. La réinsertion professionnelle et le retour aux études chez les personnes en début d’évolution d’un trouble psychotique. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088182ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Villegas C, Ibabe I, Arnoso A. People at risk of social exclusion: mental health, structural-economic factors and sociocultural factors ( Personas en riesgo de exclusión social: salud mental, factores económico-estructurales y socio-culturales). INTERNATIONAL JOURNAL OF SOCIAL PSYCHOLOGY 2020. [DOI: 10.1080/02134748.2020.1840235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Izaskun Ibabe
- Universidad del País Vasco / Euskal Herriko Unibertsitatea
| | - Ainara Arnoso
- Universidad del País Vasco / Euskal Herriko Unibertsitatea
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26
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Gale-Grant O, Dazzan P, Lappin JM, Donoghue K, Reininghaus U, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Morgan C, Heslin M. Diagnostic stability and outcome after first episode psychosis. J Ment Health 2020; 30:104-112. [DOI: 10.1080/09638237.2020.1818191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Oliver Gale-Grant
- King’s College London, MRC Centre for Neurodevelopmental Disorders, London, UK
- King’s College London, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Paola Dazzan
- King’s College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King’s College London, National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and, London, UK
| | - Julia M. Lappin
- Faculty of Medicine, University of New South Wales, School of Psychiatry, Sydney, Australia
| | - Kim Donoghue
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ulrich Reininghaus
- King’s College London, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tim Croudace
- School of Nursing & Health Sciences, University of Dundee, Dundee, UK
| | - Peter B. Jones
- Cambridgeshire and Peterborough NHS Foundation Trust, University of Cambridge, Cambridge, UK
| | - Robin M. Murray
- King’s College London, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King’s College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Paul Fearon
- Discipline of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Gillian A. Doody
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Craig Morgan
- King’s College London, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Margaret Heslin
- King’s College London, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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27
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Cogan NA, MacIntyre G, Stewart A, Tofts A, Quinn N, Johnston G, Hamill L, Robinson J, Igoe M, Easton D, McFadden AM, Rowe M. "The biggest barrier is to inclusion itself": the experience of citizenship for adults with mental health problems. J Ment Health 2020; 30:358-365. [PMID: 32762384 DOI: 10.1080/09638237.2020.1803491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Citizenship has been promoted within mental health for several decades however, its application in the field of mental health policy and practice is relatively novel. The voices of people who experience mental health problems (MHPs) are often absent in ongoing discourses about citizenship. AIMS To explore how adults with experience of MHPs and other life disruptions identify potential barriers to citizenship. METHOD A community based participatory research approach was adopted with peer researchers. Six focus groups (N = 40) using semi-structured interviews were conducted, consisting of participants who had experience of MHPs and other life disruption(s) within the last 5 years. The focus groups were audio recorded, transcribed verbatim and analysed in NVIVO using a thematic approach. RESULTS Three major themes associated with participants lived experiences of barriers to citizenship were identified: 'stigmatisation (internal & external) creates further divide'; 'being socially excluded leads to isolation'; and 'a sense of difference (as perceived by the self and others)'. CONCLUSIONS Those who have experienced major life disruption(s) face multi-level barriers to citizenship. An awareness of such barriers has important implications for mental health research, policy and practice. Citizenship-oriented implementation strategies that aim to address multi-level barriers merit further investigation.
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Affiliation(s)
| | - Gillian MacIntyre
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Ailsa Stewart
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Abigail Tofts
- School of Psychological Science and Health, Glasgow, UK
| | - Neil Quinn
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Gordon Johnston
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Linda Hamill
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - John Robinson
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Michael Igoe
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Duncan Easton
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Anne Marie McFadden
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Michael Rowe
- Department of Psychiatry, Yale University, New Haven, CT, USA
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28
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Adamus C, Mötteli S, Jäger M, Richter D. Independent Housing and Support for non-homeless individuals with severe mental illness: randomised controlled trial vs. observational study - study protocol. BMC Psychiatry 2020; 20:319. [PMID: 32560681 PMCID: PMC7304176 DOI: 10.1186/s12888-020-02712-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/01/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Social inclusion is essential for an adequate rehabilitation process for people with serious mental illness (SMI). Various supported housing settings aim to promote housing competencies and social inclusion in service users. Nevertheless, there is a strong preference in service users for independent living. We aim to evaluate the effectiveness and efficiency of Independent Housing and Support (IHS) compared to institutionalised residential care settings and other treatment as usual conditions (RCS/TAU) in two cities in Switzerland. METHODS This is a prospective multi-centre, four-arm, non-inferiority cohort study investigating the effectiveness and efficiency of IHS and RCS/TAU for people with SMI. Effectiveness will be measured by a standardised measure of social inclusion as primary outcome as well as by measures of functioning and well-being. Efficiency will be analysed on the basis of service usage and costs associated with the different housing settings. Participants will be consecutively recruited and subsequently enrolled between April 2019 and December 2020 and assessed at baseline and after six, twelve and after 24 months. At one study site, 56 participants will be randomly assigned to one of the conditions; the other study site will be conducted as an observational study investigating 112 admitted participants. DISCUSSION While the UN Convention of the Rights of People with Disabilities aims to promote the opportunity to choose one's place of residence, the limited supply of alternative forms of housing does not guarantee genuine freedom of choice. Increased diversification and flexibility of housing support is essential. If IHS shows non-inferiority in terms of their effectiveness and efficiency, users should be allowed to choose their kind of housing support. TRIAL REGISTRATION ClinicalTrials.gov: NCT03815604, December 04, 2019.
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Affiliation(s)
- Christine Adamus
- Center for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Murtenstrasse 46, CH-3008, Bern, Switzerland.
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Psychiatrie Baselland, Liestal, Switzerland
| | - Dirk Richter
- Center for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Murtenstrasse 46, CH-3008, Bern, Switzerland
- Departement of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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29
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Roeg D, de Winter L, Bergmans C, Couwenbergh C, McPherson P, Killaspy H, van Weeghel J. IPS in Supported Housing: Fidelity and Employment Outcomes Over a 4 Year Period. Front Psychiatry 2020; 11:622061. [PMID: 33519560 PMCID: PMC7840894 DOI: 10.3389/fpsyt.2020.622061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
Background: People with severe mental illness have difficulties finding and maintaining competitive employment. This is particularly so for those living in supported housing who, by definition, have significant day-to-day support needs: in the Netherlands only 3 to 5% of people with serious mental health problems who live in supported housing are competitively employed. To support these people in finding and maintaining competitive employment, Individual Placement, and Support (IPS) was introduced within supported housing services in the Netherlands in 2015. As this is the first country that broadly implemented IPS in supported housing settings, this paper will focus on the first results regarding feasibility and effects on employment in clients of IPS in this sector. Methods: We investigated the feasibility and employment outcomes of delivering IPS in supported housing services using fidelity assessments and quarterly employment outcomes on IPS program level within eight supported housing organizations, and compared these with 21 mental health treatment organizations in the Netherlands over a 4 year period. We investigated possible reasons for our findings and their implications through qualitative evaluations of the IPS fidelity assessors' notes and additional focus groups with IPS specialists and coordinators from supported housing services and fidelity assessors. Results: The overall fidelity scores indicated reasonable implementation of the IPS model within both supported housing services and mental health services. However, there were differences between services with regard to specific fidelity items; mental health treatment organizations scored higher for team integration, whereas supported housing services scored higher for rapid job search and caseload size, diversity of jobs, and employers. Our qualitative data suggested that the difference in team integration between the two sectors was due to differences in their organizational and financial structures, as well as in the specific needs of their clients. Conversely, supported housing services had better connections with employers which facilitated more rapid job searching and greater diversity in employment opportunities. The average total client employment rate did not significantly differ; and was 25.8% per quarter in supported housing services and 29.6% in mental health treatment services. Conclusion: Implementing IPS in supported housing settings is both feasible and effective.
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Affiliation(s)
- Diana Roeg
- Research Department, Kwintes Supported Housing, Zeist, Netherlands.,Academic Center Mental Health, Tranzo, Tilburg University, Tilburg, Netherlands
| | - Lars de Winter
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands
| | - Cris Bergmans
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands
| | | | - Peter McPherson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jaap van Weeghel
- Academic Center Mental Health, Tranzo, Tilburg University, Tilburg, Netherlands.,Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands
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30
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Henderson C, Gronholm PC. Mental Health Related Stigma as a 'Wicked Problem': The Need to Address Stigma and Consider the Consequences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1158. [PMID: 29865225 PMCID: PMC6024896 DOI: 10.3390/ijerph15061158] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/17/2018] [Accepted: 05/30/2018] [Indexed: 12/31/2022]
Abstract
Recent reviews on the evidence base for mental health related stigma reduction show that under certain conditions interpersonal contact is effective in promoting more positive attitudes, reduced desire for social distance, and increased stigma related knowledge (knowledge which disconfirms beliefs based on stereotypes). Short-term interventions may have effects that are attenuated over time; longer term programmes may support sustained improvements, but research following up long-term interventions is scarce. However, the effectiveness of these interventions should not obscure the nature of stigma as a social problem. In this article we describe stigma as a 'wicked problem' to highlight some implications for intervening against stigma and evaluating these efforts. These include the risks of unintended consequences and the need to continually reformulate the concept of stigma, to ensure that tackling stigma at the structural, interpersonal, and intrapersonal levels become part of the core business of stakeholder organisations. We compare the main targets of anti-stigma programmes with what is known about the sources of stigma and discrimination and their impacts to identify targets for future intervention. In some cases, interventions have been directed at the interpersonal level when structural level intervention is also needed; in others, systematic reviews have not so far identified any interventions.
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Affiliation(s)
- Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK.
| | - Petra C Gronholm
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK.
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.
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