Meaning of resilience as described by people with schizophrenia

'Changing People's Hearts': The Lived Expertise Perspective of Communicating With Nursing Students at a Mental Health Clinical Placement

Escalating rates of mental illness emphasise the necessity for sufficient and appropriate mental health services. However, stigma and discrimination remain and can be seen through the multifaceted ways nurses communicate. Clinical placements, where nursing students engage directly with individuals experiencing mental illness, are vital for addressing these challenges by fostering empathy and reducing stigma. This study aimed to explore how individuals with lived experience of mental illness experience the communication of nursing students during their participation in the mental health nursing clinical placement, Recovery Camp. Using a Heideggerian phenomenological approach, five individuals with lived experience of mental illness, referred to as Experts by Experience, participated in individual semi-structured interviews. van Kaam's psychophenomenological approach was used for data analysis. The findings highlight the importance of being Valued for My Lived Experience Expertise, which emerged as a central theme. The two primary themes were Communication and Engagement. Communication entailed students demonstrating Active Listening and Attributes and Engagement was seen through Actions and Behaviours and Rapport. The findings support the growing body of evidence highlighting the substantial impact of Experts by Experience on mental health nursing education. Integrating Experts by Experience into mental health nursing education enhances communication skills by improving students' understanding of mental illness directly from those who experience it. These changes are essential for advancing nursing education and improving mental health services.

Making Sense of Recovery From First Psychosis With Antipsychotic Medication: A Qualitative Phenomenological Study

BACKGROUND AND HYPOTHESIS

Recovering from a first psychosis is a highly individual process and requires the person to make sense of their experiences. Clinicians, in turn, need to comprehend these first-person perspectives, creating a mutual sense-making dynamic. Antipsychotic medication is a substantial part of psychosis treatment. Providing insight in the lived experience of recovery with antipsychotics could improve the mutual understanding and help bridge the gap between the perspective of the clinician and that of the person recovering from psychosis.

STUDY DESIGN

14 persons in recovery from a first psychosis with the use of antipsychotics were interviewed. Their narratives were analyzed using Interpretative Phenomenological Analysis (IPA).

STUDY RESULTS

Five overarching themes were found, representing important and meaningful experiences in recovering with antipsychotic medication. Theme 1: antipsychotics as external dampening (4 subthemes); Theme 2: shifting of realities; Theme 3: pace of recovery; Theme 4: antipsychotics' influence on identity; and Theme 5: is it truly the antipsychotics?

CONCLUSIONS

Our findings show that recovery from psychosis with antipsychotics is an all-encompassing, multi-faceted, and ambivalent experience. The themes found in this research could inspire clinicians to discuss less obvious aspects of the experience of recovering with antipsychotics. Even more so, paying attention to the first-person perspective could lead to a more thorough understanding and benefit therapeutic relationships.

Family resilience experiences of individuals with schizophrenia-family caregivers dyads: Qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Family resilience is an important determinant of family caregivers' coping with difficulties of life and stress effectively. Family resilience factors contribute to the family's adaptation to difficulties. From the perspective of the individual living with schizophrenia and family, family resilience focuses not on the losses experienced but on the strengths. WHAT DOES THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Many factors such as routines, positive cognitions, intra-family communication, family support and love as a healing force that contribute to family resilience were identified from the common perspective of the individual diagnosed with schizophrenia-family caregiver dyads. The climate of love within the family is an important strength both for the patient diagnosed with schizophrenia and for the family caregivers. Mutual support between family members, their listening to each other and sharing experiences with each other during this disease process are therapeutic for both parties and make them resilient. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Family resilience factors should be considered in planning psychosocial interventions to be applied to individuals diagnosed with schizophrenia and family caregivers. The clinical use of psychosocial support interventions in family resilience which help both the individual diagnosed with schizophrenia and the family caregivers to gain a positive perspective, to improve their problem-solving skills, and to support each other within the family should be expanded. Displaying approaches aimed at increasing the climate of love and strengthening correct communication techniques within the family towards both the individual diagnosed with schizophrenia and the family caregiver should be supported. Psychiatric nurses' focusing on family resilience from a systemic perspective in chronic mental illnesses such as schizophrenia strengthens the patient and the family. This perspective focuses on functional dimensions and protects mental health despite existing problems.

ABSTRACT

INTRODUCTION: Family resilience is one of the important concepts that should be addressed in chronic mental illnesses.

AIM

This study was aimed at investigating family resilience experiences from the perspective of individuals diagnosed with schizophrenia-family caregiver dyads.

METHOD

The study was conducted in the Adult Psychiatry inpatient and outpatient unit of a university hospital in a province in western Turkey using the phenomenological method. By using the purposeful sampling method, 20 participants were selected in the study. Of them, 10 were family caregivers and 10 were patients diagnosed with schizophrenia. The results of the study were analysed with a dyadic approach within the framework of key processes of Walsh family resilience model. The directed content analysis method was used to analyse the data obtained from the study. COREQ checklist was used to report the research.

RESULTS

After the analysis, the following five main themes emerged: positive cognitions, routines, family support, intra-family communication and love as a healing force.

DISCUSSION

Family resilience is a structure shaped by the relationship between family members. The factors that contribute to the individual diagnosed with schizophrenia-caregiver dyads' ability to overcome difficulties in family resilience are discussed in line with the relevant literature.

IMPLICATIONS FOR PRACTICE

Intervention programs should be implemented to create an environment of love by improving relationships and communication in the family, improving problem solving and increasing support resources.

Heterogeneity of resilience and the curvilinear relationship between childhood trauma and resilience among people with schizophrenia

Background

As a group with a high incidence of childhood trauma, the differential characteristics of resilience in schizophrenia and its relationship with childhood trauma are still unclear.

Methods

A total of 626 individuals diagnosed with schizophrenia were selected from four psychiatric hospitals in northern China. Childhood trauma and resilience were measured using the Childhood Trauma Questionnaire-short form (CTQ-SF) and Connor-Davidson Resilience Scale (CD-RISC), respectively. Latent profile analysis (LPA) was used to identify the potential classes of resilience. A generalized additive mixed model (GAMM) and restricted cubic spline (RCS) was used to explore and determine the shape of the relationship between childhood trauma and resilience.

Results

Model fits of LPA showed three heterogeneous classes of resilience: moderate resilience levels (n = 312; 49.06%); high resilience levels (n = 171; 26.89%) and low resilience levels (n = 153; 24.06%). Resilience scores fluctuated depending on amount of exposure to childhood trauma. The GAMM results verified the non-linear relationship between resilience and childhood trauma, with an estimated degree of freedom higher than 1 (4.573) and p = 0.003. RCS fitted for ordinary least square (OLS) regression models determined a smooth continuous cubic curve of resilience across childhood trauma levels, and the two turning points of the curve line were 41.04 and 54.74 for childhood trauma.

Discussion

Our findings confirm the people-specific differences in the level of resilience in schizophrenia and describe the cubic curvilinear relationship between childhood trauma and resilience, which provides data support for mechanistic research and intervention in related fields.

Exploring lived experience of recovery processes in those with psychosis: a systematic review with thematic synthesis of qualitative evidence

The purpose of the study was to conduct a systematic review of literature which explores lived experiences of the manifestation, appearance of meaning, and interpretation of the recovery process in schizophrenia and determined that there needs treatment shift that is centred on personal recovery processes. The focus of this review is to examine the current recovery research of the lived experience in schizophrenia. Recovery is an idiosyncratic and debated process that emerges from the perspectives of people who experience schizophrenia. Recovery literature is gained from qualitative accounts and synthesising these accounts provides an overview of the evidence base for recovery. A search of Medline, Emcare, Cinahl and Scopus databases discovered 11 studies that were published between 2016 and 2020 that met the scope of the review. Studies were included if they used qualitative methodology to explore how individuals with schizophrenia experience the process of recovery. Studies were subjected to quality assessment using the Critical Appraisal Skills Program (CASP) Qualitative Research Checklist. Several themes were identified during the qualitative analysis. These themes were linked by a common thread. This “meta-theme” is “connection.” Connection with individual sense of self and connecting with the social world. Connecting with self enhance the capacity of those with schizophrenia to be able to connect interpersonally and intersubjectively with the social world, which is seen to lead to recovery. The reviewed literature supported the theoretical approach that the person with schizophrenia needed to regain their lost self before taking further steps in the recovery process. Further research of schizophrenia as a self – disorder being phenomenologically designed would further highlight the necessity of this for the recovery process. Such research would illuminate recovery being about who you are and not about how sane or normal you are.

Psychological Resilience to Suicidal Experiences in People with Non-Affective Psychosis: A Position Paper

It is important to understand the psychological factors which underpin pathways to suicidal experiences. It is equally as important to understand how people develop and maintain resilience to such psychological factors implicated in suicidal experiences. Exploring optimal routes to gaining this understanding of resilience to suicidal thoughts and acts in people with severe mental health problems, specifically non-affective psychosis, was the overarching aim of this position paper. There are five central suggestions: 1. investigating resilience to suicidal experiences has been somewhat over-looked, especially in those with severe mental health problems such as schizophrenia; 2. it appears maximally enlightening to use convergent qualitative, quantitative and mixed research methods to develop a comprehensive understanding of resilience to suicide; 3. relatedly, involving experts-by-experience (consumers) in suicide research in general is vital, and this includes research endeavours with a focus on resilience to suicide; 4. evidence-based models of resilience which hold the most promise appear to be buffering, recovery and maintenance approaches; and 5. there is vast potential for contemporary psychological therapies to develop and scaffold work with clients centred on building and maintaining resilience to suicidal thoughts and acts based on different methodological and analytical approaches which involve both talking and non-talking approaches.

Quality of life and its social determinants for patients with schizophrenia and family caregivers in Cambodia

Due to inadequate human and financial resource support, the development of mental health services in Cambodia has been undertaken by various non-governmental organizations (NGOs). Schizophrenia is the most common functional psychotic disorder, causing severe and chronic symptoms, and the programs provided by the NGOs should have enhanced the quality of life (QoL) of patients and their caregivers; however, epidemiological research, which is a driving force behind the recognition of mental health as a global public health concern, is lacking for schizophrenia in Cambodia. This study therefore aimed to create QoL evaluation questionnaires available in Khmer (the Cambodian language) for patients with schizophrenia and family caregivers, and to identify the social determinants and predictors of their QoL. This cross-sectional study recruited 59 patients and 59 caregivers attending three clinics operated by two NGOs: the Transcultural Psychosocial Organization (TPO) Cambodia and the Supporters for Mental Health (SUMH) Cambodia. We conducted linguistic validation of the Schizophrenia Quality of Life Questionnaire 18-item version (S-QoL 18) and the Schizophrenia Caregiver Questionnaire (SCQ), then analyzed correlations between the QoL dimensions and socio-demographic factors. The main findings of this study were as follows: 1) the newly created Khmer versions of S-QoL 18 and SCQ are relatively good psychometric tools that are suitable for research to identify patients’ and caregivers’ needs to improve their QoL; and 2) engaging in paid work or being of the post-Khmer Rouge generation results in higher QoL for patients, but having low household economic status or being affected by chronic disease leads to lower QoL for family caregivers. These findings are useful for enabling community mental health professionals and aid organizations to create programs to lessen the patient and caregiver burden in Cambodia. Further research is necessary to develop practical projects that will improve patients’ and caregivers’ QoL in various clinical settings in Cambodia.

Mediation and moderation analyses: exploring the complex pathways between hope and quality of life among patients with schizophrenia

BACKGROUND

The underlying mechanism between hope and quality of life is as yet unknown. We aim to examine the potential mediating effect of depression and resilience and the moderated effect of sex in this well-established association.

METHODS

Two hundred seven patients diagnosed with schizophrenia were administered a questionnaire battery that measured hope, depression, resilience and QOL. A multiple mediation model was used to examine the mediating effect of resilience and depression on the association between hope and QOL. A subgroup analysis was performed and a moderated mediation model was examined to find and test the moderated effect of sex on the mediation model. We used Mplus to perform moderation and mediation analyses so that the mediators and moderator could function together in the same model.

RESULT

Sex was the moderator on the direct path between hope and QOL. The relationship between hope and QOL was mediated by resilience and depression in both sexes. When compared with female patients, the effect of hope on QOL was completely mediated by resilience and depression in males. In female patients, the model was partially mediated, and the direct effect of hope on QOL was significantly negatively correlated with the level of hope.

CONCLUSION

We present a conceptual model containing the mediated effects of resilience and depression and the moderated effect of sex between hope and QOL, which we believe facilitates the understanding of these associations. This model should be useful in the formulation of strategies to improve QOL.

Factors that contribute to psychological resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses: qualitative study

BACKGROUND

Suicide is a leading cause of premature death in people with a diagnosis of schizophrenia. Although exposure to stressors can play a part in the pathways to death by suicide, there is evidence that some people with a diagnosis of schizophrenia can be resilient to the impact of suicide triggers.

AIMS

To investigate factors that contribute to psychological resilience to suicidal thoughts and behaviours from the perspectives of people with a diagnosis of schizophrenia.

METHOD

A qualitative design was used, involving semi-structured, face-to-face interviews. Twenty individuals with non-affective psychosis or schizophrenia diagnoses who had experience of suicide thoughts and behaviours participated in the study. The interviews were audio-recorded, transcribed verbatim and examined using inductive thematic analysis.

RESULTS

Participants reported that psychological resilience to suicidal thoughts and behaviours involved ongoing effort. This ongoing effort encompassed: (a) understanding experiences (including reconciliation to mental health experiences and seeking reasons to live), (b) active behaviours (including talking to people and keeping occupied), and (c) relationship dynamics (including feeling supported by significant others and mental health professionals).

CONCLUSIONS

Psychological resilience was described as a dynamic process that developed over time through the experiences of psychosis and the concomitant suicidal experiences. Psychological resilience can be understood using a multicomponential, dynamic approach that integrates buffering, recovery and maintenance resilience models. In order to nurture psychological resilience, interventions should focus on supporting the understanding and management of psychosis symptoms and concomitant suicidal experiences.

DECLARATION OF INTEREST

None.

An international survey of Psychiatric-Mental-Health Nurses on the content validity of the International Classification of Functioning, Disability and Health Core Sets for Schizophrenia

The International Classification of Functioning, Disability and Health (ICF) Core Sets for schizophrenia describe the key problems in functioning that are experienced by individuals with this disorder. This study examines the content validity of these Core Sets and aims to identify the most frequent problems faced by people with schizophrenia, considering for this analysis the perspective of Psychiatric-Mental-Health Nurses. The study complied with the COREQ checklist for qualitative studies. A total of 101 nurses from 30 countries covering all six World Health Organization regions participated in a Delphi study. Their responses in Round 1 were linked to ICF categories, retaining those reported by at least 5% of participants. In Round 2, they were asked to rate the relevance of each of these categories to the nursing care of patients with schizophrenia. This process was repeated in Round 3. A total of 2327 concepts were extracted in Round 1 and linked to ICF categories. Following the analysis, 125 categories and 31 personal factors were presented to the experts in rounds 2 and 3. Consensus (defined as agreement ≥75%) was reached for 97 of these categories and 29 personal factors. These categories corresponded to all those (N = 25) in the Brief Core Set and 87 of the 97 categories of the Comprehensive Core Set for schizophrenia. Ten new categories emerged. The Delphi process identified the problems in functioning that nurses encounter when treating individuals with schizophrenia, and the results supported the content validity of the Core Sets. We conclude that these Core Sets offer a comprehensive framework for structuring clinical information and guiding the treatment process.

A Path Analysis of Self-determination and Resiliency for Consumers Living with Mental Illness

Over the last three decades, resilience has become a key area in mental health research, practice and policy, due to its potential to positively impact on wellbeing and quality of life. Research findings have identified that resilience positively correlates with an individual's subjective sense of well-being and decreased mental health problems. Given the potential benefits of resilience for those living with mental illness, research should examine ways in which these individuals can increase their resilience levels. One such method of examining resilience in people living with mental illness is through a motivational lens. Using Self-Determination Theory (SDT) lens, this study examined the potential of a proposed model for understanding the correlation and influence of motivational constructs on the resilience of people with a lived experience of mental illness. Results illustrated a goodness-of-fit for the proposed model. Results can be used to illustrate the importance of motivation and self-determination for people living with mental illness.

Effects of Mandala Art Therapy on Subjective Well-being, Resilience, and Hope in Psychiatric Inpatients

PURPOSE

This study investigated the effects of Mandala art therapy on subjective well-being, resilience, and hope among psychiatric inpatients.

METHODS

Recruited 36 people who had been treated as inpatients in a psychiatric ward at a university hospital in Seoul, South Korea, and divided them evenly into experimental and control groups. The experimental group was required to attend a total of 8 sessions of Mandala art therapy, twice per week, between August 11 and October 30, 2015; measures of the three main variables were administered at pre-test and post-test in both groups.

RESULTS

Hope significantly increased in both groups, but the overall increase was greater in the experimental group (mean score of 9.5 and 15.3 at pre- and post-test, respectively) than in the control group (10.9 and 11.9).

CONCLUSION

These results suggest that Mandala art therapy can have a positive effect on the hope of psychiatric inpatients. However, further research concerning its effects on subjective well-being and resilience, as well as other psychological constructs, is warranted to better understand the effects of Mandala art therapy on psychiatric inpatients.

Psychological resilience in people experiencing schizophrenia and suicidal thoughts and behaviours

Background: Negative stressors can aggravate the impact of schizophrenia. However, some people find ways of combating such stressors. There is a dearth of research examining factors which enable individuals with schizophrenia to show psychological resilience.Aims: The goal of this study was to investigate resilience to negative stressors in people with disorders on the schizophrenia spectrum using a qualitative methodology.Methods: Data were collected from 23 participants who had experienced schizophrenia and suicidal thoughts and behaviours. Semi-structured interviews followed a topic guide. Participants were asked (i) what resilience meant to them, (ii) which stressors they had experienced over 12 months and (iii) how they had counteracted those stressors. Thematic analysis was conducted to identify re-occurring themes across interviews.Results: A continuum of psychological mechanisms described participants' views about the meaning of resilience which ranged from passive acceptance to resistance (e.g. withstanding pressure), and then to active strategies to counter stressors (e.g. confronting). These themes were also evident in narratives expressing personal resilience strategies but, additionally, included emotional coping techniques. External factors were highlighted that supported resilience including social support, reciprocity and religious coping.Conclusions: People with schizophrenia develop ways of being resilient to negative events which should inform therapeutic interventions.