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Kalhovde AM, Kitzmüller G. Family Caregivers' Trajectories of Distress While Caring for a Person With Serious Mental Illness. QUALITATIVE HEALTH RESEARCH 2024; 34:154-165. [PMID: 37905732 PMCID: PMC10714708 DOI: 10.1177/10497323231203627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Serious mental illness (SMI) can significantly impact the lives of individuals and their families. These families often experience great emotional distress over time due to the early onset of SMI, which in turn leads to long-term trajectories and only partial recovery. However, we do not fully understand the emotional distress of family caregivers. Thus, our aim was to enrich the understanding of the lived experiences of family caregivers' emotional trajectories of distress while caring for persons with SMI. We conducted a secondary analysis using a hermeneutic approach to the narratives of seven family caregivers from a study on living with voices unheard by others. Participants' trajectories of emotional distress came forth as being thrust on an unpredictable, intensely worrisome, and indefinite journey. The following themes highlighted this tumultuous journey: fumbling in the dark trying to grasp the incomprehensible, "on your toes"-enduring unpredictability, facing different forms of fear, and battling waves of sadness and regret. Caregivers face multiple threats to their well-being and sometimes even to their health. Their distress appeared to vary according to their relationship with the person with SMI, whether they lived with the ill person, illness trajectory, and amount of violent or suicidal behavior. The results underscore the need for individualized and timely information, opportunities for dialogue with healthcare providers with and without the person with SMI, and inclusion in care planning. Caregivers who have experienced trauma, threats of violence, and rejection require special attention.
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Bhavsar V, Onwumere J. Researching family violence in mental health care: correspondence on Labrum and Solomon, PSM, 2020. Psychol Med 2023; 53:2706-2707. [PMID: 32878655 DOI: 10.1017/s0033291720003074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vishal Bhavsar
- Section of Women's Mental Health, Health Services and Population Research Department, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Juliana Onwumere
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychology, King's College London, London, UK
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Wildman EK, MacManus D, Harvey J, Kuipers E, Onwumere J. Prevalence of violence by people living with severe mental illness against their relatives and its associated impacts: A systematic review. Acta Psychiatr Scand 2023; 147:155-174. [PMID: 36316292 PMCID: PMC10107449 DOI: 10.1111/acps.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Violence perpetration by adults with severe mental illness (SMI) specifically towards their relatives is a sensitive topic and a largely neglected area that has consequences and implications for different stakeholders, including healthcare providers. This paper sought to systematically review the relevant literature, to identify the types and rates of violence by people with SMI against their relatives, and to develop a detailed understanding of its reported impacts. METHODS A systematic review, registered with PROSPERO (registration number CRD42019150784), was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review comprised searches of Medline, Embase, PsycInfo and CINAHL databases, supplemented by manual searches. Data from 38 papers using mixed methodologies were reviewed. RESULTS Key findings highlighted that relatives experienced different types of violence, including physical, verbal, psychological, financial violence, and violence directed towards property. Different types often co-occurred. Mothers were the group most likely to report being victims, compared with other relatives. Reported impacts of violence on relatives included mental ill health (e.g., psychological distress, post-traumatic stress symptoms) and the deterioration, and in some cases the permanent breakdown, of family relationships and the family unit. However, relatives often continued to provide a framework of support for patients, despite risks to their own safety. CONCLUSION Findings speak to the importance of future research extending the focus beyond the identified victimised relative or perpetrator, to also consider the impacts of violence at the family-wide level, and to improve the outcomes of families exposed to and dealing with violence by individuals living with SMI.
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Affiliation(s)
- Emilie K Wildman
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Deirdre MacManus
- Department of Forensic and Neurodevelopmental Science, King's College London, London, UK
| | - Joel Harvey
- Department of Law and Criminology, Royal Holloway, University of London, Surrey, UK
| | - Elizabeth Kuipers
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Juliana Onwumere
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
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Nurses’, patients’, and informal caregivers’ attitudes toward aggression in psychiatric hospitals: A comparative survey study. PLoS One 2022; 17:e0274536. [PMID: 36174064 PMCID: PMC9522285 DOI: 10.1371/journal.pone.0274536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 08/30/2022] [Indexed: 12/02/2022] Open
Abstract
Attitudes toward aggression is a controversial phenomenon in psychiatry. This study examined and compared attitudes toward patient aggression in psychiatric hospitals from the perspectives of nurses, patients and informal caregivers and identified factors associated to these attitudes. A total of 2,424 participants completed a self-reported instrument regarding attitudes toward aggression (12-items Perception of Aggression Scale; POAS-S). We analysed data from nurses (n = 782), patients (n = 886), and informal caregivers (n = 765). Pearson’s r correlations were used to examine associations between variables. Differences between group scores were analysed using ANOVA/MANOVA with post-hoc Sheffe tests. Multivariate logistic regression models and logistic regression analysis were used to examine the effects of respondents’ characteristics on their attitudes toward aggression. Nurses had significantly more negative and less tolerant perceptions toward aggression (mean [SD] 47.1 [7.5], p<0.001) than the patients (mean [SD] 44.4 [8.2]) and the informal caregivers (mean [SD] 45.0 [6.9), according to the POAS-S total scores. The same trend was found with the dysfunction and function sub-scores (mean [SD] 25.3 [4.1] and 15.0 [3.6], respectively); the differences between the groups were statistically significant (p <0.001) when nurses’ scores were compared to those of both the patients (mean [SD] 23.7 [5.3] and 14.0 [4.1], respectively) and the informal caregivers (mean [SD] 24.4 [4.2] and 13.9 [3.5], respectively). The study offers new understanding of aggressive behavior in different treatment settings where attitudes toward patient behavior raises ethical and practical dilemmas. These results indicate a need for more targeted on-the-job training for nursing staff, aggression management rehabilitation programs for patients, and peer-support programs for informal caregivers focused on patient aggression.
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Labrum T, Newhill C, Simonsson P, Flores AT. Family Conflict and Violence by Persons with Serious Mental Illness: How Clinicians Can Intervene During the COVID-19 Pandemic and Beyond. CLINICAL SOCIAL WORK JOURNAL 2022; 50:102-111. [PMID: 35034993 PMCID: PMC8751667 DOI: 10.1007/s10615-021-00826-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
Although most persons living with serious mental illness (SMI) do not act violently, this population is at a modestly increased risk of engaging in violence, with family members being the most common victims. Consequently, evidence suggests that a sizable minority of family members-many of whom are caregivers-have experienced violence by their relative with SMI. The risk of conflict and violence in families of persons with SMI is likely currently heightened due to a range of challenges resulting from the COVID-19 pandemic (e.g., interruption in treatment services and the occurrence of arguments while sheltering in place together). As such, during the pandemic, it is particularly important that clinicians intervene with these populations to prevent conflict and violence and strengthen their relationships with each other. Based on available evidence, we recommend that clinical interventions aiming to do so address the following topics with family members and/or persons with SMI: mutual understanding; positive communication; effective problem-solving; symptoms and psychiatric crises; triggers to, and early warning signs of, anger and conflict; and strategies for de-escalating conflict and managing violent behavior. We offer suggestions for how clinicians can address these topics and recommend established clinical resources providing more guidance in this area.
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Affiliation(s)
- Travis Labrum
- School of Social Work, University of Pittsburgh, Pittsburgh, USA
| | | | - Peter Simonsson
- Lewis Katz School of Medicine, Temple University, Philadelphia, USA
| | - Ana T. Flores
- School of Social Work, University of Pittsburgh, Pittsburgh, USA
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‘You’d think they’d know’: social epistemology and informal carers of mental health service users. SOCIAL THEORY & HEALTH 2021. [DOI: 10.1057/s41285-021-00172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sheaves B, Johns L, Černis E, Griffith L, Freeman D. The challenges and opportunities of social connection when hearing derogatory and threatening voices: A thematic analysis with patients experiencing psychosis. Psychol Psychother 2021; 94:341-356. [PMID: 33124757 PMCID: PMC8247012 DOI: 10.1111/papt.12303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Relationships with other people are important determinants of the course of psychosis, yet social isolation is common. This study sought to learn about the patient experience of being around other people when hearing derogatory and threatening voices (DTVs). DESIGN A qualitative interview study. METHODS Fifteen participants with experience of hearing DTVs in the context of non-affective psychosis were recruited from NHS services. Data were obtained by semi-structured interviews and analysed using thematic analysis. RESULTS Three themes were identified: (1) reasons why interacting with people is difficult when hearing DTVs; (2) the relationship between social connection and DTVs; and (3) factors which enable voice hearers to connect with others. A further ten sub-themes are outlined as reasons why hearing DTVs led to lower social connection, including difficulties during conversations (e.g., the concentration required is hard), negative expectations of interactions (e.g., fearing negative judgement from others), and difficulties sharing experiences of voices (e.g., people will be hurt or upset if I tell them about the voices). Isolation was a common response to hearing DTVs but also a time of vulnerability for hearing voices. Managing the challenges of interacting with people led to some improvements in DTVs. CONCLUSIONS There are understandable reasons why hearing DTVs leads to lower social connection. Yet isolating oneself can also be a time of vulnerability for DTVs. Social connection might be one vehicle for disengaging from and disputing derogatory and threatening voice content. The effect on voice hearing of social recovery interventions warrants further investigation. PRACTITIONER POINTS Participants shared 10 reasons why being around people is challenging when hearing derogatory and threatening voices. These typically affected both daily social experiences and contact with clinicians. Common initial responses to hearing DTVs were to reduce contact with people, experience difficulties connecting during conversations and to avoid sharing the experience of voice hearing. However, social isolation was a time of vulnerability to DTVs, and hence, increasing social connection might be a target for interventions. A range of factors enabled voice hearers to manage social situations, for example: the fostering of trust, self-acceptance, learning when it is better to stay at home, and developing a narrative to explain voice hearing to others. Addressing the barriers to connecting with others might have an important role in personal recovery from voice hearing.
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Affiliation(s)
- Bryony Sheaves
- Department of PsychiatryUniversity of OxfordUK,Oxford Health NHS Foundation TrustUK
| | - Louise Johns
- Department of PsychiatryUniversity of OxfordUK,Oxford Health NHS Foundation TrustUK
| | - Emma Černis
- Department of PsychiatryUniversity of OxfordUK,Oxford Health NHS Foundation TrustUK
| | | | | | - Daniel Freeman
- Department of PsychiatryUniversity of OxfordUK,Oxford Health NHS Foundation TrustUK
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Rolin SA, Bareis N, Bradford JM, Rotter M, Rosenfeld B, Pauselli L, Compton MT, Stroup TS, Appelbaum PS, Dixon LB. Violence risk assessment for young adults receiving treatment for early psychosis. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 76:101701. [PMID: 33887604 PMCID: PMC8140412 DOI: 10.1016/j.ijlp.2021.101701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/22/2021] [Accepted: 04/11/2021] [Indexed: 06/12/2023]
Abstract
AIM Although the absolute risk of violence is small for individuals with mental illnesses, a specific subgroup of individuals who appear to be at increased risk for violence includes young people experiencing emerging or early psychosis. Prior research has identified risk factors for violence in this population, though no prior studies using a formal risk assessment tool have been identified. This study used the Historical Clinical Risk Management-20, version 3 (HCR-20) to identify risk of future violence among a sample of young adults with early psychosis and relevant predictors of risk unique to this population. METHODS The HCR-20 was administered to a sample of young adults with early psychosis (N = 53) enrolled at one OnTrackNY site, part of a statewide program providing early intervention services to young adults presenting with a first episode of non-affective psychosis. A Confirmatory Factor Analysis (CFA) was conducted to explore the relative importance of the HCR-20 items for this population. RESULTS The average age of participants was 21.9 years (SD 3.6 years) and most were male (69.8%, n = 37). Most patients were assessed to be at low risk for future violence based on the Case Prioritization summary risk rating (67.9%, n = 36). The CFA identified 4 items that were not of relative predictive value in identifying the risk of violence in this sample: history of substance use (item H5), history of major mental disorder (item H6), living situation (item R2), and personal support (item R3). CONCLUSION This study presents a formal approach to assessing violence risk in a population at elevated risk of violence, demonstrates the feasibility of using a standardized risk assessment tool in early intervention services, and identifies factors of particular importance associated with predicting violence in this population. Future research should implement violence risk assessment with a structured tool such as the HCR-20 and assess its accuracy in predicting future violent behavior in this setting.
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Affiliation(s)
- Stephanie A Rolin
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Natalie Bareis
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Jean-Marie Bradford
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Merrill Rotter
- Department of Psychiatry, Albert Einstein College of Medicine, New York, NY, USA
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, NY, New York, USA
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside/West, New York, NY, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - T Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
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Wildman EK, MacManus D, Kuipers E, Onwumere J. COVID-19, severe mental illness, and family violence. Psychol Med 2021; 51:705-706. [PMID: 33706822 PMCID: PMC8007936 DOI: 10.1017/s0033291721000490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Emilie K. Wildman
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Deirdre MacManus
- Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Elizabeth Kuipers
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Juliana Onwumere
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
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10
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Violence by Persons with Serious Mental Illness Toward Family Caregivers and Other Relatives: A Review. Harv Rev Psychiatry 2021; 29:10-19. [PMID: 33417373 DOI: 10.1097/hrp.0000000000000263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Persons living with serious mental illness (SMI) are at a modestly increased risk of committing violence and are disproportionately likely to target family members when they do commit violence. In this article, we review available evidence regarding violence by persons with SMI toward family members, many of whom are caregivers. Evidence suggests that a sizable minority of family members with high levels of contact with persons with SMI have experienced violence, with most studies finding rates of past year victimization to be 20% or higher. Notable risk factors for family violence pertaining specifically to persons with SMI include substance use, nonadherence to medications and mental health treatment, history of violent behavior, and recent victimization. Notable risk factors pertaining specifically to the relationships between persons with SMI and family members include persons with SMI relying on family members for tangible and instrumental support, family members setting limits, and the presence of criticism, hostility, and verbal aggression. As described in qualitative studies, family members often perceive violence to be connected to psychiatric symptoms and inadequate treatment experiences. We argue that promising strategies for preventing violence by persons with SMI toward family members include (1) better engaging persons with SMI in treatment, through offering more recovery-oriented care, (2) strengthening support services for persons with SMI that could reduce reliance on family members, and (3) supporting the capabilities of family members to prevent and manage family conflict. The available interventions that may be effective in this context include McFarlane's Multifamily Group intervention and the Family-to-Family educational program.
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Craig C, Hiskey S, Spector A. Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations. Expert Rev Neurother 2020; 20:385-400. [PMID: 32196399 DOI: 10.1080/14737175.2020.1746184] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Compassion focused therapy (CFT) is an increasingly popular therapeutic modality. Its holistic and integrative approach to universal human suffering means that it is well placed as a transdiagnostic therapy. Research into its effectiveness and acceptability has increased over the previous 10 years as the therapy has evolved, and to help consider its status as an evidence-based therapy research concerning its treatment outcomes needs evaluating.Areas covered: This paper reviews research investigating the effectiveness of CFT in clinical populations.Expert opinion: CFT shows promise for a range of mental health problems, especially when delivered in a group format over at least 12 hours. This is important for funding bodies and commissioning groups to consider as they allocate healthcare resources in light of current evidence-based practice. CFT is demonstrably well accepted by clients and clinicians and there is now a clear need for an updated, universally deployed, standard manual to direct future research. This will be critical in enabling widespread implementation and further adoption into mainstream clinical practice, will address the lack of standardization in the current research, and pave the way for further randomized control trials aimed at reducing existing methodological limitations.
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Affiliation(s)
- Catriona Craig
- Buckinghamshire Older People's Psychology Services, The Whiteleaf Centre, Aylesbury, Buckinghamshire, UK, Oxford Health NHS Foundation Trust
| | - Syd Hiskey
- Department of Clinical Psychology, The Oaks Hospital, Colchester, Essex, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology University College London, London, UK
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Noiriel A, Verneuil L, Osmond I, Manolios E, Revah-Levy A, Sibeoni J. The Lived Experience of First-Episode Psychosis: A Systematic Review and Metasynthesis of Qualitative Studies. Psychopathology 2020; 53:223-238. [PMID: 33120385 DOI: 10.1159/000510865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/11/2020] [Indexed: 11/19/2022]
Abstract
Both research and care have focused on first episodes of psychosis (FEPs) as a way to address the issue of early stages of schizophrenia and to reduce the duration of untreated psychosis. The objective of this study was to explore specifically the lived experience of FEP from the point of view of patients and their families by applying a metasynthetic approach, including a systematic review of the literature and analyses of qualitative studies on the subject. This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting FEP from the patient or family's perspective. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them. Thirty-eight articles were included, covering data from 554 participants (378 patients and 176 relatives). Three themes emerged from the analyses: (1) When and how does a FEP start? (2) What are its negative and positive aspects? (3) How do patients and families recount FEPs? Our results found important discrepancies between the experiences of patients and those of their families, especially regarding positive aspects. In light of the confusion reported by patients and notable in our results, we also discuss the gap between the name, FEP, and the lived experience of patients and family members in order to explore its practical implications.
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Affiliation(s)
| | | | - Ingrid Osmond
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, France
| | - Emilie Manolios
- ECSTRA Team, UMR-1153, Inserm, Université de Paris, Paris, France.,Service de Psychologie et Psychiatrie de Liaison et d'Urgences, Hôpital Européen Georges Pompidou AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France
| | - Anne Revah-Levy
- ECSTRA Team, UMR-1153, Inserm, Université de Paris, Paris, France.,Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, France
| | - Jordan Sibeoni
- ECSTRA Team, UMR-1153, Inserm, Université de Paris, Paris, France, .,Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, France,
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Rapisarda F, Corbière M, Lesage AD, De Benedictis L, Pelletier JF, Felx A, Leblanc Y, Vallarino M, Miglioretti M. Development and validation of the mental health professional culture inventory. Epidemiol Psychiatr Sci 2019; 29:e80. [PMID: 31839026 PMCID: PMC8061147 DOI: 10.1017/s2045796019000787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 10/02/2019] [Accepted: 10/30/2019] [Indexed: 12/03/2022] Open
Abstract
AIMS No instrument has been developed to explicitly assess the professional culture of mental health workers interacting with severely mentally ill people in publicly or privately run mental health care services. Because of theoretical and methodological concerns, we designed a self-administered questionnaire to assess the professional culture of mental health services workers. The study aims to validate this tool, named the Mental Health Professional Culture Inventory (MHPCI). The MHPCI adopts the notion of 'professional culture' as a hybrid construct between the individual and the organisational level that could be directly associated with the professional practices of mental health workers. METHODS The MHPCI takes into consideration a multidimensional definition of professional culture and a discrete number of psychometrically derived dimensions related to meaningful professional behaviour. The questionnaire was created and developed by a conjoint Italian-Canadian research team with the purpose of obtaining a fully cross-cultural questionnaire and was pretested in a pilot study. Subsequently, a validation survey was conducted in northern Italy and in Canada (Montreal area, Quebec). Data analysis was conducted in different steps designed to maximise the cross-cultural adaptation of the questionnaire through a recursive procedure consisting of performing a principal component analysis (PCA) on the Italian sample (N = 221) and then testing the resulting factorial model on the Canadian sample (N = 237). Reliability was also assessed with a test-retest design. RESULTS Four dimensions emerged in the PCA and were verified in the confirmatory factor analysis: family involvement, users' sexuality, therapeutic framework and management of aggression risk. All the scales displayed good internal consistency and reliability. CONCLUSIONS This study suggests the MHPCI could be a valid and reliable instrument to measure the professional behaviour of mental health services workers. The content of the four scales is consistent with the literature on psychosocial rehabilitation, suggesting that the instrument could be used to evaluate staff behaviour regarding four crucial dimensions of mental health care.
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Affiliation(s)
- F. Rapisarda
- Department of Psychology, University of Milano-Bicocca, 1 Piazza dell'Ateneo Nuovo, 20126, Milano, Italy
| | - M. Corbière
- Department of Education – Career Counselling, Université du Québec à Montréal, Montréal, Canada
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
| | - A. D. Lesage
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
| | - L. De Benedictis
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
| | - J. F. Pelletier
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
- Department of Psychiatry, Yale University School of Medicine, Yale Program for Recovery & Community Health, New Haven, CT, USA
| | - A. Felx
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
| | - Y. Leblanc
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
| | - M. Vallarino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - M. Miglioretti
- Department of Psychology, University of Milano-Bicocca, 1 Piazza dell'Ateneo Nuovo, 20126, Milano, Italy
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Onwumere J, Zhou Z, Kuipers E. Informal Caregiving Relationships in Psychosis: Reviewing the Impact of Patient Violence on Caregivers. Front Psychol 2018; 9:1530. [PMID: 30233448 PMCID: PMC6129604 DOI: 10.3389/fpsyg.2018.01530] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/02/2018] [Indexed: 02/02/2023] Open
Abstract
A modest association can be found between people with a schizophrenia spectrum diagnosis (psychosis) and perpetrating acts of violence. When a person with psychosis does engage in violence, it is their informal carers, when compared to those from the general population, who are more likely to be the targets, and violence will often occur within the family home. Despite the importance of carer support for improving patient outcomes, our understanding of how carers are impacted by patient initiated violence in psychosis remains limited. This paper reviews literature documenting the effects of patient-initiated violence in psychosis on carer functioning. The review comprised searches of Medline, PsychInfo, Embase, and Web of Science databases and the hand searches of reference lists from relevant published papers. The review was limited to English language publications from inception to 11th September 2017, and where carer experiences following reports of violence from patients with psychosis were specifically recorded. Data from 20 papers using mixed methodologies were reviewed. Patient violence in psychosis was linked to poorer carer outcomes, including carer reports of burden, trauma, fear, and helplessness. There is, however, a significant need for further studies to systematically quantify the impact and correlates of patient initiated violence on psychosis caregivers, and improve prevention.
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Affiliation(s)
- Juliana Onwumere
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, United Kingdom
| | - Zheng Zhou
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
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