Exploring Professional Help-Seeking for Mental Disorders

Conceptual framework of mental health literacy: Results from a scoping review and a Delphi survey

Mental health literacy (MHL) has been identified as a factor influencing early help-seeking for mental health problems (MHPs) and stigmatizing attitudes. However, the lack of consensus on its definition has led to considerable heterogeneity in measurement and, consequently, methodological challenges in comparing data. In this way, the present study was conducted with the following objectives: in Phase I, mapping the existing literature through a scoping review; in Phase 2, 28 experts in the field of mental health participated to develop a consensus statement on the relevance and importance of the findings from Phase 1. A total of 37 articles were included for review. Notable nuances were identified in the conceptualization of MHL, particularly with regard to the fact that it should not be limited to mental disorders but should also encompass mental health. Furthermore, the sociocultural influence was highlighted as shaping MHL, recognizing it as a modifiable competence that adapts to different contexts and life stages, involving both individual and collective levels. The experts deemed the findings pertinent and relevant with a high degree of consensus, except for factors related to MHL. This framework provides a refined definition of MHL and related factors that should be taken into account to guide nursing and other disciplines' studies and interventions on MHL. The evolution of this concept includes dimensions to be considered in future research, especially when developing new measurement instruments or implementing educational programmes. This knowledge and skills cannot be determined globally without considering the context and development of the individual.

'When a patient chooses to die at home, that's what they want… comfort, home': Brilliance in community-based palliative care nursing

INTRODUCTION

To redress the scholarly preoccupation with gaps, issues, and problems in palliative care, this article extends previous findings on what constitutes brilliant palliative care to ask what brilliant nursing practices are supported and promoted.

METHODS

This study involved the methodology of POSH-VRE, which combines positive organisational scholarship in healthcare (POSH) with video-reflexive ethnography (VRE). From August 2015 to May 2017, inclusive, nurses affiliated with a community health service who delivered palliative care, contributed to this study as co-researchers (n = 4) or participants (n = 20). Patients who received palliative care (n = 30) and carers (n = 16) contributed as secondary participants, as they were part of observed instances of palliative care. With a particular focus on the practices and experiences that exceeded expectations and brought joy and delight, the study involved capturing video-recordings of community-based palliative care in situ; reflexively analysing the recordings with the nurses; as well as ethnography to witness, experience, and understand practices and experiences. Data were analysed, teleologically, to clarify what brilliant practices were supported and promoted.

RESULTS

Brilliant community-based palliative care nursing largely involved maintaining normality in patients' and carers' lives. The nurses demonstrated this by masking the clinical aspects of their role, normalising these aspects, and appreciating alternative 'normals'.

CONCLUSION

Redressing the scholarly preoccupation with gaps, issues, and problems in palliative care, this article demonstrates how what is ordinary is extraordinary. Specifically, given the intrusiveness and abnormalising effects of technical clinical interventions, brilliant community-based palliative care can be realised when nurses enact practices that serve to promote a patient or carer to normality.

PATIENT OR PUBLIC CONTRIBUTION

Patients and carers contributed to this study as participants, while nurses contributed to this study as co-researchers in the conduct of the study, the analysis and interpretation of the data, and the preparation of the article.

An Assessment of Austrian School Students' Mental Health and Their Wish for Support: A Mixed Methods Approach

The mental health of school students has been severely impacted by the aftermath of the COVID-19 pandemic. The present study used a mixed methods approach to assess students' mental health and examine their wishes for support to improve their psychological well-being. We further investigated gender and age group differences in the amount of clinically relevant mental health problems and the roles that mental health and gender had on desired support. Between April and May 2022, a total of 616 Austrian students aged between 14 and 20 participated in a cross-sectional online survey (77.4% female; 19.8% male; 2.8% non-binary) assessing wishes for support regarding mental well-being and mental health indicators (depression: PHQ-9; anxiety: GAD-7; insomnia: ISI; stress: PSS-10; eating disorders: SCOFF; alcohol abuse: CAGE). A wish for support was expressed by 46.6% of the students. Qualitative content analysis revealed that the two most important categories of desired support types were "professional help" and "someone to talk to". The group of students with a wish for support in general significantly more often showed clinically relevant depression, anxiety, insomnia, eating disorders, or high stress symptoms. Students that wished for professional help significantly more often exceeded the cut-off for clinically relevant depression, anxiety, and high stress. Those who wished for someone to talk to significantly more often exceeded the cut-off for clinically relevant eating disorders. The results indicate a great need for support for young people's mental health problems and that this need is even more urgent for students.

Help-seeking among psychiatrically hospitalized military personnel at risk for suicide

INTRODUCTION

Promoting help-seeking is a key suicide prevention strategy. Yet, research on help-seeking patterns by high-risk individuals is limited. This study examined help-seeking among United States military Service members admitted for psychiatric inpatient care.

METHODS

Participants were active duty Service members (N = 111) psychiatrically hospitalized for a suicide-related event. Data were collected as part of a larger randomized controlled trial. Reported types and perceived helpfulness of resources sought 30 days before hospitalization were examined. Hierarchical binary logistic regressions were used to examine associations among types of helping resources, mental health treatment stigma, and perceived social support.

RESULTS

Approximately 90% of participants sought help prior to hospitalization, most frequently from behavioral health providers and friends. Accessed resources were generally considered helpful. Adjusting for covariates, mental health treatment stigma was not associated with seeking help from any resource type. Higher perceived social support was associated with greater likelihood of help-seeking from a friend (OR = 1.08, p = 0.013 [95% CI = 1.02, 1.14]). Marital status, education level, and organizational barriers were associated with specific types of resources, and/or not seeking help.

CONCLUSION

Help-seeking is a complex human behavior. Promoting help-seeking among vulnerable subgroups requires further understanding of multiple interconnected factors.

'it was that … specialist … that finally listened to us … that's probably a weird answer to what you were expecting': Clinician and carer perspectives on brilliant feeding care

INTRODUCTION

To extend research on positive aspects of health care, this article focusses on health care for children who tube-feed-this is because knowledge about tube-feeding for children is limited and fragmented. This is achieved by consulting with clinicians and carers who supported children who tube-feed to clarify their understandings of and experiences with brilliant feeding care.

METHODS

Nine clinicians and nine carers who supported children who tube-fed were interviewed. The interview transcripts were analysed thematically.

RESULTS

Findings highlighted several features of brilliant feeding care-namely: practices that go above and beyond; attentiveness; empowerment; being 'on the same page'; hopefulness and normalcy.

CONCLUSIONS

These findings show that seemingly trivial or small acts of care can make a significant meaningful difference to carers of children who tube-feed. Such accounts elucidate brilliant care as grounded in feasible, everyday actions, within clinicians' reach. The implications associated with these findings are threefold. First, the findings highlight the need for clinicians to listen, be attuned and committed to the well-being of children who tube-feed and their carers, share decision-making, source resources, and instil hope. Second, the findings suggest that carers should seek out and acknowledge clinicians who listen, involve them in decision-making processes, and continue to source the resources required to optimize child and carer well-being. Third, the findings point to the need for research to clarify the models of care that foster brilliant feeding care, and the conditions required to introduce and sustain these models.

PATIENT OR PUBLIC CONTRIBUTION

All of the carers and clinicians who contributed to this study were invited to participate in a workshop to discuss, critique, and sense-check the findings. Three carers and one clinician accepted this invitation. Collectively, they indicated that the findings resonated with them, and they agreed with the themes, which they indicated were well-substantiated by the data.

Prevalence of common mental disorders and treatment receipt for people from ethnic minority backgrounds in England: repeated cross-sectional surveys of the general population in 2007 and 2014

BACKGROUND

Concerns persist that some ethnic minority groups experience longstanding mental health inequalities in England. It is unclear if these have changed over time.

AIMS

To assess the prevalence of common mental disorders (CMDs) and treatment receipt by ethnicity, and changes over time, using data from the nationally representative probability sample in the Adult Psychiatric Morbidity Surveys.

METHOD

We used survey data from 2007 (n = 7187) and 2014 (n = 7413). A Clinical Interview Schedule - Revised score of ≥12 indicated presence of a CMD. Treatment receipt included current antidepressant use; any counselling or therapy; seeing a general practitioner about mental health; or seeing a community psychiatrist, psychologist or psychiatric nurse, in the past 12 months. Multivariable logistic regression assessed CMD prevalence and treatment receipt by ethnicity.

RESULTS

CMD prevalence was highest in the Black group; ethnic variation was explained by demographic and socioeconomic factors. After adjustment for these factors and CMDs, odds ratios for treatment receipt were lower for the Asian (0.62, 95% CI 0.39-1.00) and White Other (0.58, 95% CI 0.38-0.87) groups in 2014, compared with the White British group; for the Black group, this inequality appeared to be widening over time (2007 treatment receipt odds ratio 0.68, 95% CI 0.38-1.23; 2014 treatment receipt odds ratio 0.23, 95% CI 0.13-0.40; survey year interaction P < 0.0001).

CONCLUSIONS

Treatment receipt was lower for all ethnic minority groups compared with the White British group, and lowest among Black people, for whom inequalities appear to be widening over time. Addressing socioeconomic inequality could reduce ethnic inequalities in mental health problems, but this does not explain pronounced treatment inequalities.

Intention to seek professional and non-professional emotional help among Jewish young adults in Israel

Young adulthood is a major and significant stage in life encompassing various life transitions which may increase the risk of developing emotional crises. Receiving mental health treatment and turning to nonprofessional resources for support can ease such emotional burdens. However, many of those in need of such help do not turn to professional services and, rather, tend to rely on themselves. The aim of this study was to examine the contribution of attitudes towards seeking professional emotional help, self-stigma, anticipated risk, anticipated utility, and social support to the intention to seek professional and nonprofessional emotional help among Jewish young adults in Israel. Participants included 282 Jewish Israeli young adults aged 18-30, recruited in person or online. They filled out a self-report questionnaire, between March and June 2017, regarding intention to seek professional and non-professional emotional help, attitudes towards seeking professional emotional help, self-stigma towards seeking professional emotional help, anticipated risk and anticipated utility of self-disclosure when seeking professional help, perceived social support and sociodemographic questions. A path analysis model was used to analyse the data. Intention to seek professional help was positively associated with positive attitudes towards seeking professional emotional help and anticipated utility and negatively with self-stigma and social support. Intention to seek nonprofessional help was positively associated with anticipated utility and social support and negatively with anticipated risk. In addition, indirect effects were found between religious affiliation and previous mental health treatment, and intention to seek professional help, through the mediating effects of attitudes and anticipated utility. Interventions for increasing intention to seek professional and nonprofessional support are important and should include reference to attitudes, anticipated utility, anticipated risk and self-stigma, and should promote mutual support and highlight the importance of support from close ones. In addition, a model for predicting intention to seek non-professional help should be developed.

Depression rates and health-seeking behavior in primary care: Andersen model of health- care utilization

Depression imposes a tremendous burden on the health-care systems. Many patients prefer informal (family & friends) over formal mental health services (MHS) provided by professionals. We aimed to investigate the prevalence of depression among primary care patients and to examine the factors predicting seeking MHS using the Andersen Health Care Utilization Model. We interviewed 300 primary care patients in Jordan. The mean age was 39.85 ± 14.45, and 80% were women. 35.7% had depression, and 28.7% had significant depression impairing daily function. The most commonly reported source of help was family members and less than one-third had the intention to seek formal MHS. The predisposing-factors domain was the only predictive of seeking MHS in depression and suicide, whereas the 'enabling' and 'need' domains were not. Knowledge, stigma and life satisfaction were predictive of seeking formal MHS. Raising awareness and empowering doctors to screen for depression is needed as less than a third would seek formal MHS.

Predictors of Professional Help-Seeking Intention Toward Depression Among Community-Dwelling Populations: A Structural Equation Modeling Analysis

Background

A low intention of professional help seeking hinders the effective treatment of depression. The factors are from the perspectives of the social, family, and individual; however, an understanding of how they interact to predict professional help-seeking intention (PHSI) is not clear.

Objectives

The objectives of the study was to investigate PHSI toward depression in a Chinese community-dwelling population and construct a predictive model of the PHSI to explore the various factors involved.

Methods

Stratified random sampling and Kish table methods were used to identify 2,000 community residents. Participants completed a series of questionnaires to measure general characteristics, PHSI, professional help-seeking attitude, depression stigma, depression knowledge, family function, and depression symptoms. Analyses included descriptive statistics and Pearson correlation analysis using SPSS 26.0 and a Structural Equation Model using Amos 22.0.

Results

The score of the PHSI was 14.92 ± 9.574. Professional help-seeking attitude (r = 0.291, p < 0.001) and depression knowledge (r = 0.077, p = 0.002) were positively related to PHSI, while a negative correlation was found between stigma (r = -0.149, p < 0.001) and PHSI. The model of the PHSI indicated a good fit with a CMIN/DF = 2.740 and RESEA = 0.032. The total effect of the influencing factors on the PHSI was listed in the following order: professional help-seeking attitude (0.676) > stigma (-0.143) > depression knowledge (0.088) > depression symptoms (-0.009) > family function (0.005). The total effect of depression knowledge on PHSI included a direct negative effect (Beta = -0.266, p < 0.001) and an indirect positive effect (0.354) through professional help-seeking attitude and stigma. Also, depression knowledge was negatively associated with stigma (Beta = -0.153, p < 0.001). Depression symptoms were negatively associated with family function (Beta = -0.282, p < 0.001), depression knowledge (Beta = -0.252, p < 0.001), and stigma (Beta = -0.102, p < 0.001), indicating that people with less severe depression symptoms had good family function, depression knowledge, and higher stigma. Family function contributed a positive effect on depression knowledge directly (Beta = 0.145, p < 0.001) and a totally positive effect (0.033) on stigma.

Conclusion

The PHSI toward depression is low among Chinese community residents. Professional help-seeking attitude, depression knowledge, and family functioning were facilitators of PHSI, and stigma and the severity of depression symptoms were barriers to PHSI. This study provides reference for the development of policies and guidelines to promote community residents to actively seek professional mental health help. Future policies can focus on multicollaboration among the government, mental health services, and families to increase the mental health resources, improve family functioning, enhance mental health literacy (MHL) of the public, and reduce depression stigma to ease the burden of this mental health issue.

Help-seeking for psychological distress and its association with anxiety in the oldest old - results from the AgeQualiDe cohort study

Objectives: This study aimed to examine aspects of help-seeking for psychological distress and its association with increased anxiety symptoms in the oldest old.Method: Baseline data from AgeQualiDe, a multicenter cohort study of people aged 85 and over recruited in primary care, were analyzed. Help-seeking for psychological distress (items from the Camberwell Assessment of Need for the Elderly) was analyzed using ordinal and logistic regression models as a function of increased anxiety symptoms (Geriatric Anxiety Inventory-Short Form ≥ 3), as well as relevant socio-demographic and health-related covariates.Results:N = 155 (18.1% of the sample) reported having experienced psychological distress recently and were thus included in the analysis. Among those, 26.5% reported experiencing increased anxiety symptoms. On a descriptive level, 76.8% sought informal, 29.0% sought formal, and 18.1% sought no help for psychological distress. In covariate-adjusted regression models, increased anxiety was significantly associated with increased use of informal support (OR: 2.92, 95% CI: 1.31-6.48), but was neither associated with formal (OR: 0.72, 95% CI: 0.26-1.97) nor no help-seeking (OR: 0.28, 95% CI: 0.08-1.05).Conclusion: A large proportion of those experiencing psychological distress sought support from informal sources in this study. Anxiety symptoms in the oldest old were associated with the increased use of informal support, but not formal support or no help-seeking. Training and support for people providing informal help to those with mental health problems should be promoted to reduce a possible burden. However, future research addressing underlying mechanisms is needed.

Inequalities in referral pathways for young people accessing secondary mental health services in south east London

Differences in health service use between ethnic groups have been well documented, but little research has been conducted on inequalities in access to mental health services among young people. This study examines inequalities in pathways into care by ethnicity and migration status in 12-29 years old accessing health services in south east London. This study analyses anonymized electronic patient record data for patients aged 12-29 referred to a south east London mental health trust between 2008 and 2016 for an anxiety or non-psychotic depressive disorder (n = 18,931). Multinomial regression was used to examine associations between ethnicity, migration status, and both referral source and destination, stratified by age group. Young people in the Black African ethnic group were more likely to be referred from secondary health or social/criminal justice services compared to those in the White British ethnic group; the effect was most pronounced for those aged 16-17 years. Young people in the Black African ethnic group were also significantly more likely to be referred to inpatient and emergency services compared to those in the White British ethnic group. Black individuals living in south east London, particularly those who identify as Black African, are referred to mental health services via more adverse pathways than White individuals. Our findings suggest that inequalities in referral destination may be perpetuated by inequalities generated at the point of access.

'Sharing things with people that I don't even know': help-seeking for psychological symptoms in injured Black men in Philadelphia

Objectives: Psychological distress is common in survivors of traumatic injury, yet across United States' trauma systems, it is rare that standard injury care integrates psychological evaluation and professional mental healthcare. The purpose of this study was to explore help-seeking for psychological symptoms in injured Black men living in Philadelphia. Design: A subset of a cohort of 551 injured Black men admitted to a Trauma Center in Philadelphia participated in qualitative interviews that explored their perceptions of psychological symptoms after injury and the factors that guided their decision to seek professional mental health help. Data from 32 participants were analyzed for narrative and thematic content. Results: Three overarching themes emerged: (1) facilitators of help-seeking, (2) barriers to help-seeking, and (3) factors underlying the decision not to consider professional help. Five participants felt that their injury-related psychological distress was severe enough to merit professional help despite any perceived barriers. Seventeen participants identified systemic and interpersonal obstacles to professional help that prevented them from seeking this kind of care. These included: financial constraints, limited access to mental healthcare services, and fear of the judgments of mental healthcare professionals. Ten participants would not consider professional help; these men perceived a lack of need and sufficiency in their existing social support networks. Conclusions: Research is needed to inform or identify interventions that diminish the impact of barriers to care, and identify from whom, where, and how professional mental health help might be more effectively offered to injured Black men in recovery environments like Philadelphia.

Pathways to Help-Seeking Among Black Male Trauma Survivors: A Fuzzy Set Qualitative Comparative Analysis

Many Black men suffer symptoms of traumatic stress in the aftermath of traumatic injury, and they also often carry social concerns, including experiences of discrimination and stigma, and a lack of financial resources. The objective of the present study was to understand how traumatic symptoms and social factors combine in complex ways toward the outcome of psychological help-seeking. We analyzed qualitative and quantitative data from 32 injured Black men admitted to a Level 1 trauma center. Qualitative interviews explored their attitudes toward seeking professional psychological help. We analyzed quantitative data, collected using validated instruments, on posttraumatic stress and depression symptoms, financial worry, and discrimination/stigma. Fuzzy set qualitative comparative analysis (fsQCA) was conducted by calibrating each condition to fuzzy set membership scores based on our knowledge of the causal conditions and the cases. We then constructed truth tables for QCA analysis using fsQCA software. Three causal pathways for psychological help-seeking were identified: Two pathways showed that severe trauma symptoms in the absence of financial worry were sufficient for seeking help, whereas the third showed that financial worry and discrimination in the absence of trauma symptoms were sufficient for help-seeking. We identified two causal pathways for negated help-seeking, in which low posttraumatic symptom severity and low levels of discrimination or financial worry were sufficient for not seeking psychological help. The QCA analysis revealed multiple pathways for psychological help-seeking among Black men who suffer trauma. These findings highlight the need for further research to understand complex pathways toward psychological help-seeking in this population.

A Critical Perspective on Mental Health News in Six European Countries: How Are "Mental Health/Illness" and "Mental Health Literacy" Rhetorically Constructed?

In this study, we aim to contribute to the field of critical health communication research by examining how notions of mental health and illness are discursively constructed in newspapers and magazines in six European countries and how these constructions relate to specific understandings of mental health literacy. Using the method of cluster-agon analysis, we identified four terminological clusters in our data, in which mental health/illness is conceptualized as "dangerous," "a matter of lifestyle," "a unique story and experience," and "socially situated." We furthermore found that we cannot unambiguously assume that biopsychiatric discourses or discourses aimed at empathy and understanding are either exclusively stigmatizing or exclusively empowering and normalizing. We consequently call for a critical conception of mental health literacy arguing that all mental health news socializes its audience in specific understandings of and attitudes toward mental health (knowledge) and that discourses on mental health/illness can work differently in varying contexts.

Self-labeling as having a mental or physical illness: the effects of stigma and implications for help-seeking

PURPOSE

Personal and perceived stigma can hinder persons in appraising their symptoms as constituting part of a mental illness (self-labeling), an important early step in the help-seeking process. This study examines the impact of personal and perceived stigma on self-labeling and provides prospective data on the possible connections between self-labeling and help-seeking behavior.

METHODS

Personal stigmatizing attitudes, perceived stigma and self-labeling behavior as well as their statistical connections were cross-sectionally investigated in a community sample of 207 participants with a present untreated mental health problem. We further conducted prospective analyses to investigate possible associations between self-labeling and help-seeking behavior at 3 and 6 month follow-ups. Socio-demographics, previous treatment and depression symptoms were also measured as potential confounders.

RESULTS

Personal stigmatizing attitudes were significantly more pronounced in respondents who self-labeled as physically compared to mentally ill, while group differences in levels of perceived stigma were not. Self-labeling as physically or mentally ill increased the likelihood of seeking help from the health service provider deemed most suitable for that label (physical: GP, p <0.05; mental: MHP, p < 0.1) compared to persons who applied no self-label.

CONCLUSIONS

The findings suggest that personal stigmatizing attitudes-rather than perceived stigma-impact on self-labeling, and highlight the need for interventions that assist persons with mental illness in overcoming those attitudes. They also underscore the possible impact of self-labeling in the help-seeking process and underline the important role of GPs in mental health care. Further, preferably epidemiological research into the matter would be desirable.

Can a Community-Led Intervention Offering Social Support and Health Education Improve Maternal Health? A Repeated Measures Evaluation of the PACT Project Run in a Socially Deprived London Borough

Social adversity can significantly influence the wellbeing of mothers and their children. Maternal health may be improved through strengthened support networks and better health literacy. Health improvement at the population level requires optimizing of the collaboration between statutory health services, civic organizations (e.g., churches, schools), as well as community groups and parents. Two key elements in improving community engagement are co-production and community control. This study evaluated a co-produced and community-led project, PACT (Parents and Communities Together), for mothers in a deprived south London borough. The project offered social support and health education. Intended effects were improvements in mental health, health literacy, and social support, assessed by standardized measures in a pre-post design. Sixty-one mothers consented to take part in the evaluation. Significant improvements were found in mental health measures, in health literacy, for those with low literacy at baseline, and in overall and some specific aspects of social support. Satisfaction with the project was high. We found that the project engaged local populations that access statutory health services relatively less. We conclude that community-organized and community-led interventions in collaboration with statutory health services can increase accessibility and can improve mothers' mental health and other health-related outcomes.

Talk to Me, Not at Me: An Ethnographic Study on Health-Related Help-Seeking Behavior Among Socially Marginalized Danish Men

Research shows that men tend to have delayed health-related help-seeking behavior. In this ethnographic study, we explored influential factors related to health-related help-seeking behavior among socially marginalized men who seem not to benefit from existing municipal health care services in a large Danish municipality. The study included 200 hours of participant observations and 25 ethnographic interviews with men between 45 and 65 years of age in their own homes and in public parks among their peers. In this study, we found that the men had several complex and interacting social- and health-related conditions, which seemed to affect their health-related help-seeking behavior. We conclude that collaborative initiatives between the outreach team who occasionally visits bench sites in the public parks and the municipal health care services in the local areas could lay the groundwork for encouraging men's health-related help-seeking behavior and aid men in supporting each other.

Attitude Toward Seeking Professional Psychological Help Among Community-Dwelling Population in China

OBJECTIVE

To explore the attitudes and factors in seeking professional psychological help among a Chinese community-dwelling population in order to promote positive help-seeking behaviors and better utilization of mental health services.

METHODS

Using system and simple random sampling with Kish selection table methods, 912 community-dwelling residents were included in this study and asked about their attitudes toward seeking professional psychological help, depression symptoms, family function, depression literacy, help-seeking intention, and stigma.

RESULTS

Scores on the Attitudes Toward Seeking Professional Psychological Help scale (ATSPPH-SF) indicated a neutral attitude toward openness to seeking treatment for psychological problems and a negative attitude toward the value and need to seek treatment with a negative total score. Multiple linear regression analysis showed that gender, age, social support (employment status and family function), depression literacy, stigma, and help-seeking intention are significantly associated with attitude toward seeking professional psychological help.

CONCLUSION

The overall attitude toward seeking professional psychological help is not optimistic, thus, more efforts are needed to enhance understanding. Effective interventions including mental health education, training of mental health professionals, and popularizing the use of mental health services are essential, especially for the at-risk population.

Archival data review of intimate partner homicide-suicide in Jamaica, 2007 - 2017: focus on mental health and community response

Objective.

To identify social and behavioral patterns and mental health concerns associated with intimate partner homicide-suicide (IPHS) in Jamaica through an analysis of media and police reports.

Methods.

This was an archival data review of police records and print, radio, and television reports of IPHS incidents from January 2007 – June 2017 in Jamaica. The 27 cases found were qualitatively analyzed using pre-identified codes and open coding to generate themes and patterns.

Results.

A prevalence rate of 0.1 per 100 000 was determined. In all cases, males were the homicide-offender. Sociodemographic patterns associated with IPHS incidents—age, personality traits, choice of weapon, and time of occurrence—were consistent with previous findings. Common triggers were offender obsession, sexual jealousy, and fear of separation. Despite reports of mental health concerns in both male and female partners, neither the couples nor community members sought help prior to the homicide-suicide.

Conclusion.

These findings demand a change in cultural attitudes toward domestic disputes and mental health concerns, and a redefining of the community’s responsibility in IPHS. The warning signs associated with IPHS should be part of existing violence and suicide prevention programs.

Do Help-Seeking Behaviors Influence the Recovery of People With Mental Illness?

Personal recovery is a primary focus for health care professionals and people with mental illness, with current research focused on understanding the concepts and factors that facilitate a positive recovery journey. A person's ability to seek help is an area that has demonstrated promise. Although there is a wealth of literature that exists on the barriers to someone seeking help, there is little empirical evidence to demonstrate the connection between help-seeking behaviors and personal recovery for people with mental illness. The current study used quantitative measures to examine whether help-seeking behaviors would facilitate personal recovery. One hundred twenty people with mental illness completed two valid and reliable surveys that measured help-seeking behaviors and personal recovery. Using multiple linear regression analysis, results revealed that help-seeking behaviors significantly influenced the personal recovery of participants. Understanding the constructs that facilitate a positive personal recovery journey for a person with mental illness may be viewed as a critical area of inquiry. These results allow for future inquiry into the connection between intention and behavior, as there has been an identified disparity between the need for assistance and use of services. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 33-38.].

Validity and psychometric properties of the Self-Identification as Having a Mental Illness Scale (SELF-I) among currently untreated persons with mental health problems

Conceptualizing own symptoms as potential signs of a mental illness is an important, yet under-researched step towards appropriate help. Few validated measures address recognition and identification of own mental illness. Aim of this study is to investigate performance and correlates of the 'Self-Identification as Having a Mental Illness' scale (SELF-I) in a group of 229 currently untreated individuals with mental health problems, predominantly depression. Measures included: self-identification with having a mental illness (SELF-I), depressive and somatic symptom severity (PHQ-9 and PHQ-15), illness perceptions (B-IPQ-R-C), and sociodemographic variables. Principal-component analysis revealed in a unidimensional factor structure. The SELF-I showed good reliability in terms of internal consistency (Cronbach's alpha, 0.85-0.87) and re-test reliability over three months (Intraclass correlation coefficient, 0.74). Associations with depressive symptoms, previous treatment experiences and self-labelling demonstrated construct and criterion validity. Low associations with somatic symptoms and with illness-perceptions as measured by the B-IPQ-R-C indicated discriminant validity. We did not observe any floor or ceiling effects. The SELF-I scale is a brief, unidimensional and reliable measure of self-identification as having a mental illness that offers useful research perspectives.

Willingness to Ask Tor Help Among Persons with Severe Mental illness: Call for Research

There are times when people with severe mental illness (SMI) must be willing to ask for help (e.g., with managing symptoms). But what makes one person ask for help and another decide to go it alone? We used logistic regression to assess willingness to request assistance among 150 people with SMI. Hispanics were more likely (OR 8.51, CI 2.05-35.36, p < .01) than Caucasians to be willing to ask for help, and people with the highest incomes (relative to the lowest) were more likely (OR 7.23, CI 1.76-29.97, p > .01). Individuals with the most social support (relative to the least) were more likely (OR 12.36, CI 3.01-50.85, p < .001) to be willing to request assistance, and people who were willing to ask for help were more likely (OR 2.07, CI 1.01-4.26, p < .05) than less willing individuals to report being happy. More research is needed in order to better understand predisposition to seek aid, and interventions are needed that promote it.

The Stigma of Mental Illness as a Barrier to Self Labeling as Having a Mental Illness

The aim of this study was to investigate whether personal stigma decreases self-identification as having a mental illness in individuals with untreated mental health problems. We interviewed 207 persons with a currently untreated mental health problem as confirmed by a structured diagnostic interview. Measures included symptom appraisal, self-identification as having a mental illness (SELFI), self-labeling (open-ended question on the nature of their problem) stigma-related variables (explicit and implicit), as well as sociodemographics, current symptom severity, and previous treatment. Support for discrimination and implicit stigmatizing attitude were both associated with lower likelihood of self-identification. More social distance and support for discrimination were associated with less self-labeling. Previous treatment was the strongest predictor of symptom appraisal, SELFI, and self-labeling. Destigmatizing mental illness could increase awareness of personal mental health problems, potentially leading to lower rates of untreated mental illness.

Conditional Disclosure on Pathways to Care: Coping Preferences of Young People at Risk of Psychosis

The interrelationship between stigma and help-seeking is under-researched among children and adolescents. This study explored stigma in relation to pathways to care among young people putatively in an early stage of increased risk of developing psychotic disorders. "Pathways to care" was defined as help-seeking and support from informal and formal resources, and increased risk was determined through the presence of persistent psychotic-like experiences and internalizing/externalizing psychopathology. Twenty-nine qualitative interviews were analyzed using thematic analysis. We defined the superordinate theme in these data as "conditional disclosure," a concept reflecting the rules and prerequisites that influenced how/whether participants sought help. Through parallels between these findings and established stigma theory, we examined how these conditions could be interpreted as influenced by stigma. Our findings demonstrate the influence of stigma on young people's perceptions of a range of pre-clinical symptoms, and on how they seek support for these symptoms.

Public discourse on mental health and psychiatry: Representations in Swedish newspapers

Mass media plays a central role in shaping public discourse on health and illness. In order to examine media representations of mental health and expert knowledge in this field, two major Swedish daily newspapers from the year 2009 were qualitatively analysed. Drawing on the theory of social representations, the analysis focused on how issues concerning mental health and different perspectives are represented. The results show how the concept of mental illness is used in different and often taken-for-granted ways and how the distinction between normal and pathological is a central underlying question. Laypersons' perspectives are supplemented by views of professionals in the newspapers, where signs of confidence and dependence on expert knowledge are juxtaposed with critique and expressions of distrust. The newspaper discourse thus has salient argumentative features and the way that conflicts are made explicit and issues concerning authoritative knowledge are addressed indicates ambivalence towards the authoritative role of expert knowledge concerning mental health. In this way, the newspapers provide a complex epistemic context for everyday sense-making that can be assumed to have implications for relations between laypersons and professionals in the field of mental health.

Development of depression in survivors of childhood and adolescent cancer: a multi-level life course conceptual framework

As therapeutic and supportive care interventions become increasingly effective, growing numbers of childhood and adolescent cancer survivors face a myriad of physical and psychological sequelae secondary to their disease and treatment. Mental health issues, in particular, present a significant problem in this unique patient population, with depression affecting a sizable number of childhood and adolescent cancer survivors. Multiple key determinants impact a survivor's risk of developing depression, with variables traversing across biologic, individual, family, community, and global levels, as well as spanning throughout the life course of human development from the preconception and prenatal periods to adulthood. A multi-level life course conceptual model offers a valuable framework to identify and organize the diverse variables that modulate the risk of developing depression in survivors of childhood and adolescent cancer. This review describes the first multi-level life course perspective applied to development of depression in childhood and adolescent cancer survivors. This conceptual framework may be used to guide the investigation of mental health interventions for SCACs to ensure that key determinants of depression occurrence are adequately addressed across various levels and throughout the life trajectory.

Barriers and facilitators of help-seeking among unemployed persons with mental health problems: a qualitative study

Background

Unemployed people with mental health problems often do not use mental health services and therefore do not benefit from available therapies. As unemployed individuals outside the healthcare system are a hard-to-reach group, barriers to and facilitators of mental health service use are poorly understood. The purpose of this study was to identify barriers to and facilitators of help-seeking and service use based on experiences of unemployed people with mental health problems.

Methods

Fifteen qualitative semi-structured individual interviews were conducted with unemployed persons who reported mental health problems. Interview topics included individual experience with help-seeking and mental health service use with a focus on barriers and facilitators. Transcripts were analysed using qualitative content analysis and major themes were identified.

Results

Participants reported being treated as “different” within their social environment as well as by health care professionals because of their mental health problems, which resulted in a lack of self-esteem and avoidance of help-seeking. Interviewees associated negative attributes with help-seeking such as helplessness and weakness. They equated psychiatric medication with illegal drugs and worried about the risk of addiction. However, social support and a desire for change on the other hand increased the motivation to search for help. Employment agency staff were mostly perceived as supportive by individuals seeking mental health services.

Conclusions

Unemployed individuals with mental health problems faced barriers and facilitators when seeking help on three different levels: (1) mental health literacy; (2) stigma and discrimination; and (3) structures and conditions of health care. Awareness and attitudes of health care professionals concerning mental health issues should be improved. Stigmatisation of people with mental illnesses should be reduced in health care settings. Training for employment agency staff concerning mental health problems and services is recommended.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-1997-6) contains supplementary material, which is available to authorized users.

Understanding Help-Seeking Behavior in Depression: A Qualitative Synthesis of Patients' Experiences

Despite decades of evidence-based interventions, depression remains a great challenge for public health due to enormous treatment gap and lag which, at least partially, result from low professional help-seeking by people suffering from depressive symptoms. In this article, we aim to gain a better understanding of help-seeking behavior in depression, and how to intervene effectively decreasing treatment gap and delay by using a meta-ethnography approach-an interpretive technique to systematically synthesize qualitative data. It integrates views and experiences of 474 individuals with depression across 20 papers. Findings suggest several interrelated major concepts-help-seeking as a threat to identity, social networks as a conflict or support, and alternative coping strategies as the main factor for treatment delay-as well as multiple relational, structural, attitudinal, cognitive, culture-specific, or gender-specific barriers. A model of help-seeking as a threat to identity is developed and discussed in the context of existing research.

The Experience of Depression: A Qualitative Study of Adolescents With Depression Entering Psychotherapy

There is a lack of research in health psychology on the subjective experience of adolescents with mental health disorders. The aim of this study was to explore the experience of depression and the journey into therapy of young people (YP) diagnosed with depression. Semi-structured interviews were carried out with six YP (5 female, aged 15-19). Interviews were analyzed using Interpretative Phenomenological Analysis. The following four key themes were identified: "Suffering is experienced as overwhelming," "An experience of loneliness and isolation," "Struggling to understand the suffering," and "Therapy as a last resort." Reasons for a delay in accessing treatment were not knowing what is "normal," the feeling that they have to deal with it by themselves, and/or the lack of a caring adult who supports the YP in getting help. The findings suggest the ongoing importance of reducing stigma and promoting mental health education for YP as well as parents, school staff, and health professionals.