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Rafn BS, Andersen MF, Sørensen V, Bjerre ED, Baandrup L, Vernal DL, Mors O, Knop FK, Wolf RT, Tolver A, Firth J, Nøhr N, Skou ST, Ebdrup BH, Midtgaard J. Value of gym-based group exercise versus usual care for young adults receiving antipsychotic medication: study protocol for the multicenter randomized controlled Vega trial. BMC Psychiatry 2023; 23:634. [PMID: 37648977 PMCID: PMC10466717 DOI: 10.1186/s12888-023-05086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Exercise is recommended to protect physical health among people with severe mental illness and holds the potential to facilitate long-term recovery. An inclusive exercise community provides an opportunity for life skill training and social connectedness and may reduce the experience of loneliness and internalized stigmatization which together may improve personal recovery. Using a pragmatic randomized design, we aim to examine the effectiveness of a gym-based exercise intervention tailored to young adults in antipsychotic treatment (i.e., Vega Exercise Community) compared to usual care. It is hypothesized that the Vega Exercise Community will be superior to usual care for personal recovery at four months. METHODS The trial will be conducted at four sites in Denmark from which 400 participants, aged 18 to 35 years, who are in current treatment with antipsychotic medications for the management of schizophrenia spectrum or affective disorders, will be recruited. Participants will be randomized (2:1) to Vega Exercise Community or usual care. Vega Exercise Community includes three weekly group-based exercise sessions hosted in commercial functional training centers delivered by certified Vega instructors. After four months, participants in Vega Exercise Community will be randomized (1:1) to minimal versus extended support with regards to sustained physical activity. Data will be collected at baseline, four, six and 12 months. The primary outcome is personal recovery assessed by Questionnaire about the Process of Recovery at four months. Behavioral symptoms, health-related quality of life, metabolic health, and program costs will be evaluated to further determine the effectiveness and cost-effectiveness of the Vega Exercise Community. Finally, the quality of life and physical and mental health of the participants' primary relative will be evaluated. DISCUSSION The results of this trial may have important implications for health, sustained physical activity, and recovery for individuals in treatment with antipsychotics. Given the pragmatic design, positive results may readily be implemented by mental health care professionals to promote exercise as an integrated part of treatment of severe mental illness. TRIAL REGISTRATION Clinical Trials.gov (NCT05461885, initial registration June 29th, 2022). WHO Universal Trial Number (UTN): U1111-1271-9928.
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Affiliation(s)
- Bolette Skjødt Rafn
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark.
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Martin Færch Andersen
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - Victor Sørensen
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Eik Dybboe Bjerre
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Lone Baandrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Lammers Vernal
- Psychiatry, Aalborg University Hospital North, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Filip Krag Knop
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Rasmus Trap Wolf
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Anders Tolver
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nikolaj Nøhr
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
- , Arca, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark.
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Killaspy H, Harvey C, Brasier C, Brophy L, Ennals P, Fletcher J, Hamilton B. Community-based social interventions for people with severe mental illness: a systematic review and narrative synthesis of recent evidence. World Psychiatry 2022; 21:96-123. [PMID: 35015358 PMCID: PMC8751572 DOI: 10.1002/wps.20940] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
People living with severe mental illness (SMI) are one of the most marginalized groups in society. Interventions which aim to improve their social and economic participation are of crucial importance to clinicians, policy-makers and people with SMI themselves. We conducted a systematic review of the literature on social interventions for people with SMI published since 2016 and collated our findings through narrative synthesis. We found an encouragingly large amount of research in this field, and 72 papers met our inclusion criteria. Over half reported on the effectiveness of interventions delivered at the service level (supported accommodation, education or employment), while the remainder targeted individuals directly (community participation, family interventions, peer-led/supported interventions, social skills training). We identified good evidence for the Housing First model of supported accommodation, for the Individual Placement and Support model of supported employment, and for family psychoeducation, with the caveat that a range of models are nonetheless required to meet the varied housing, employment and family-related needs of individuals. Our findings also highlighted the importance of contextual factors and the need to make local adaptations when "importing" interventions from elsewhere. We found that augmentation strategies to enhance the effectiveness of social interventions (particularly supported employment and social skills training) by addressing cognitive impairments did not lead to transferable "real life" skills despite improvements in cognitive function. We also identified an emerging evidence base for peer-led/supported interventions, recovery colleges and other interventions to support community participation. We concluded that social interventions have considerable benefits but are arguably the most complex in the mental health field, and require multi-level stakeholder commitment and investment for successful implementation.
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Affiliation(s)
- Helen Killaspy
- Department of Epidemiology and Applied Clinical Research, Division of PsychiatryUniversity College LondonLondonUK,Camden & Islington NHS Foundation TrustLondonUK
| | - Carol Harvey
- Psychosocial Research Centre, Department of PsychiatryUniversity of MelbourneMelbourneVICAustralia,North Western Mental HealthParkvilleVICAustralia
| | - Catherine Brasier
- Department of Occupational TherapySocial Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe UniversityMelbourneVICAustralia
| | - Lisa Brophy
- Department of Occupational TherapySocial Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe UniversityMelbourneVICAustralia
| | | | - Justine Fletcher
- Centre for Mental Health, Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVICAustralia
| | - Bridget Hamilton
- Centre for Psychiatric NursingSchool of Health Sciences, University of MelbourneMelbourneVICAustralia
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Zhang X, Liu B, Zang D, Li Y, Xiao S, Yu Y. Preferences for WeChat-Based and Hospital-Based Family Intervention Among Caregivers of People Living with Schizophrenia. Patient Prefer Adherence 2022; 16:635-645. [PMID: 35283626 PMCID: PMC8906870 DOI: 10.2147/ppa.s338936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study examines the preferences for WeChat-based and hospital-based family intervention among caregivers of people living with schizophrenia (PLS) and identify correlates associated with these preferences. PATIENTS AND METHODS A cross-sectional study was conducted with 449 family caregivers of PLS. Face-to-face interviews were conducted to collect information on socio-demographics, preferences for WeChat-based and hospital-based family intervention, social support, and coping. RESULTS Over 72.16% of participants endorsed hospital-based family intervention, while 50.11% endorsed WeChat-based family intervention. Endorsement of WeChat-based family intervention was associated with younger age (OR=0.42, 95% CI: 0.22, 0.79), WeChat use (OR=12.90, 95% CI: 7.48, 22.23), and higher social support (OR=1.03, 95% CI: 1.01, 1.04). Endorsement of hospital-based family intervention was associated with lower education (OR=0.19-0.37, 95% CI: 0.07, 0.66) and WeChat use (OR=3.27, 95% CI: 1.91, 5.59). CONCLUSION The studies showed a higher endorsement rate for hospital-based family intervention than WeChat-based family intervention and provide implications for developing targeted family intervention programs based on participants' own unique characteristics.
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Affiliation(s)
- Xiantao Zhang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, People’s Republic of China
| | - Bibo Liu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, People’s Republic of China
| | - Difan Zang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, People’s Republic of China
| | - Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, People’s Republic of China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, People’s Republic of China
| | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, People’s Republic of China
- Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Correspondence: Yu Yu, Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, Hunan, 410008, People’s Republic of China, Tel +1 2037459531, Email
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Townsend M, Pareja K, Buchanan-Hughes A, Worthington E, Pritchett D, Brubaker M, Houle C, Mose TN, Waters H. Antipsychotic-Related Stigma and the Impact on Treatment Choices: A Systematic Review and Framework Synthesis. Patient Prefer Adherence 2022; 16:373-401. [PMID: 35210756 PMCID: PMC8859276 DOI: 10.2147/ppa.s343211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/15/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Antipsychotics are a class of medications primarily used to treat individuals with psychotic disorders. They have also been indicated for patients with other psychiatric conditions, such as post-traumatic stress disorder and major depressive disorder. Non-adherence is prominent amongst individuals prescribed antipsychotics, with medication-related self-stigma and social stigma identified as major factors. No previous reviews have focused on stigma associated specifically with antipsychotic medication. This systematic literature review aimed to synthesise evidence on the prevalence of stigmatising attitudes and behaviours related to antipsychotic treatment and understand their impact on antipsychotic treatment initiation and continuation. METHODS Two independent reviewers screened studies from databases, congress proceedings, ClinicalTrials.gov, and PsychU.org; relevant studies reported quantitative or qualitative data on antipsychotic-related stigma in adults with psychotic disorders, mood disorders, borderline personality disorder or anxiety disorders, or healthcare providers or caregivers of these patients, and any impact on treatment. Framework synthesis facilitated extraction and synthesis of relevant information; quantitative and qualitative data were coded and indexed against a pre-specified thematic framework by two independent reviewers. RESULTS Forty-five articles reporting on 40 unique studies were included; 22 reported quantitative data, 16 reported qualitative data, and two reported quantitative and qualitative data relating to antipsychotic-related stigma. Framework synthesis identified four themes: 1) impact of antipsychotic treatment on a) social stigma or b) self-stigma; 2) impact of side effects of antipsychotic treatment on a) social stigma or b) self-stigma; 3) impact of route of administration of antipsychotic treatment on stigma; 4) impact of stigma on the use of antipsychotics. CONCLUSION This systematic literature review found that antipsychotic-related social and self-stigma is a factor in non-adherence to antipsychotics. Further research should examine stigma in a wider range of patients and the extent to which clinicians' treatment decisions are impacted by the potential stigma associated with antipsychotic medications.
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Affiliation(s)
- Michael Townsend
- Gateway Counseling Center, New York, NY, USA
- Correspondence: Michael Townsend, Email
| | - Kristin Pareja
- Department of Global Value and Real World Evidence, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA
| | | | - Emma Worthington
- Evidence Development Division, Costello Medical Consulting Ltd, Cambridge, UK
| | - David Pritchett
- Evidence Development Division, Costello Medical Consulting Ltd, Cambridge, UK
| | - Malaak Brubaker
- Department of US Medical Affairs, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA
| | - Christy Houle
- Department of Value and Real World Evidence, Lundbeck Inc, Deerfield, IL, USA
| | - Tenna Natascha Mose
- Department of Value and Real World Evidence, Lundbeck Inc, Deerfield, IL, USA
| | - Heidi Waters
- Department of Global Value and Real World Evidence, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA
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Adlbrecht L, Bartholomeyczik S, Mayer H. Mechanisms of impact and contextual aspects of a dementia special care unit in long-term care: a process evaluation. BMC Geriatr 2021; 21:680. [PMID: 34876048 PMCID: PMC8650270 DOI: 10.1186/s12877-021-02637-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to care concepts. Little information is available on how these facilities and care concepts bring about changes in the targeted outcomes. Such knowledge is needed to understand the effects of care concepts and to consciously shape further developments. This study aimed to explore the mechanisms of impact of a specific care concept from a dementia special care unit and the contextual aspects that influence its implementation or outcomes. METHODS Using a qualitative approach to process evaluation of complex interventions, we conducted participating observations and focus groups with nurses and single interviews with ward and nursing home managers. Data were collected from two identical dementia special care units to enhance the contrasts in the analysis of two non-specialised nursing homes. We analysed the data thematically. We conducted 16 observations, three group interviews and eleven individual interviews. RESULTS We identified seven themes in three domains related to mechanisms that lead to outcomes regarding residents' and nurses' behaviour and well-being. The themes include the development of nurses' skills and knowledge, the promotion of a positive work climate, adjusted spatial structures, adjusted personnel deployment strategy "dedicated time for activities", promotion of relaxation, of engagement in activities and of engagement in social interaction of residents. The implementation and outcomes of the care concept are influenced by contextual aspects relating to the (target) population and cultural, organisational and financial features. CONCLUSIONS The study found expected and unexpected mechanisms of impact and contextual aspects. The care concept of the dementia special care unit results in higher levels of relaxation, activities, and social interaction of residents. Its implementation highly depends on the shared understanding of nursing and the skills of the nursing team. Changes in residents' characteristics result in altered effects of the concept. TRIAL REGISTRATION DRKS00011513 .
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Affiliation(s)
- Laura Adlbrecht
- Department of Nursing Science, Faculty of Social Sciences, University of Vienna, Alser Strasse 23/12, 1080, Vienna, Austria.
- Department of Health, Center for Dementia Care, Institute of Applied Nursing Sciences, FHS St. Gallen, University of Applied Sciences, Rosenbergstrasse 59, 9001, St. Gallen, Switzerland.
| | - Sabine Bartholomeyczik
- School of Nursing Science, Witten/Herdecke University, Stockumer Strasse 10, 58453, Witten, Germany
| | - Hanna Mayer
- Karl Landsteiner Private University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500, Krems an der Donau, Austria
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Mutiso V, Musyimi C, Tele A, Gitonga I, Ndetei D. Feasibility study on the mhGAP-IG as a tool to enhance parental awareness of symptoms of mental disorders in lower primary (6-10 year old) school-going children: Towards inclusive child mental health services in a Kenyan setting. Early Interv Psychiatry 2021; 15:486-496. [PMID: 32291956 DOI: 10.1111/eip.12963] [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: 09/10/2018] [Revised: 01/24/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
AIMS (1) To determine the feasibility of involving parents as key partners in school mental health activities; (2) to determine whether educating parents on mental health treatment Gap Intervention Guideline (mhGAP-IG) section on children leads to enhanced parent perception of mental health symptoms in their children; and (3) to determine context appropriate social demographic predictors of the parental awareness following the psychoeducation using the mhGAP-IG children version. METHODS Consenting parents completed the Child Behaviour Checklist (CBCL) and the Brief Problem Monitor for Parents (BPM-P) about their children at baseline and at 6 months post-baseline respectively. Immediately after post-baseline, they received psychoeducation on the importance of mental well-being in children and how to recognize symptoms of mental disorders, using the mhGAP-IG section on children. This psychoeducation was the intervention between baseline and 6 months post-baseline. We analysed means of mental disorder symptoms and prevalence of the various mental syndromes/problems on the CBCL/BPM-P scores to determine the statistical significance of the changes between baseline and 6 months. RESULTS Overall, there was significant increase (P < 0.05) in the symptoms mean scores and prevalence of syndromes/problems between baseline and 6 months post-psychoeducation. However, there were some differences between urban and rural settings and in some parents and children socio-demographics and gender that should be considered in individual cases. CONCLUSION It is feasible to include parents in school mental health programmes as key stakeholders. The mhGAP-IG section on children is a good tool for psychoeducation. However, there are predictors of outcomes that need further research.
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Affiliation(s)
- Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,University of Nairobi, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,University of Nairobi, Nairobi, Kenya
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Zhou Z, Wang Y, Feng P, Li T, Tebes JK, Luan R, Yu Y. Associations of Caregiving Knowledge and Skills With Caregiver Burden, Psychological Well-Being, and Coping Styles Among Primary Family Caregivers of People Living With Schizophrenia in China. Front Psychiatry 2021; 12:631420. [PMID: 34122169 PMCID: PMC8187614 DOI: 10.3389/fpsyt.2021.631420] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/15/2021] [Indexed: 02/03/2023] Open
Abstract
Background: There is a lack of clarity regarding the correlation of caregiving knowledge and skills with caregiving experiences of people living with schizophrenia (PLSs). To address this gap, this comprehensive study examines the relationships of caregiving knowledge and skills to the primary family caregiver's experiences of burden, psychological well-being (stress, anxiety, depression, caregiving rewarding feelings), and coping styles in China. Methods: A total of 395 primary family caregivers of PLSs were enrolled in a cross-sectional study between May 2019 and September 2019. Each family caregiver was independently assessed on caregiving knowledge and skills, caregiver burden, and psychological well-being, as well as coping styles. Results: A higher level of caregiving knowledge and skills was positively correlated with less stress (b = -0.48, P < 0.001), anxiety (b = -0.23, P = 0.029), depression (b = -0.29, P = 0.013), and more caregiving rewarding feelings (b = 0.54, P < 0.001). Also, caregivers with more knowledge and skills were more inclined to adopt positive coping strategies (b = 0.44, P < 0.001). Despite these differences, caregivers with different levels of caregiving knowledge and skills reported comparable caregiver burden (b = 0.11, P = 0.705) and the use of a passive coping style (b = 0.10, P = 0.169). Conclusion: Caregiving knowledge and skills are a reliable predictor of psychological well-being and active coping among the primary family caregivers of PLSs. These findings inform the development of psychoeducational interventions to support family caregivers of PLSs.
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Affiliation(s)
- Zonglei Zhou
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yao Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Ping Feng
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Tongxin Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jacob Kraemer Tebes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Rongsheng Luan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
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Alhadidi M, Abdullah KL, Tang LY, Danaee M, Al Hadid LAR. Knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among people diagnosed with schizophrenia in a long-term care facility. Perspect Psychiatr Care 2021; 57:225-234. [PMID: 32502330 DOI: 10.1111/ppc.12553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study assessed the level of knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among patients with schizophrenia in Jordan. DESIGN AND METHODS A cross-sectional survey was conducted on 135 patients diagnosed with schizophrenia, who had been admitted to the largest psychiatric hospital in Jordan. FINDINGS The participants had a low level of knowledge, insight, and a high level of internalized stigma. No correlation was found between these variables. Meanwhile, the educational level and vacation were found to be predictors of knowledge. PRACTICE IMPLICATIONS This can help psychiatric nurses to identify which area needs to be improved to ensure the best service and care is provided to patients diagnosed with schizophrenia.
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Affiliation(s)
- Majdi Alhadidi
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khatijah Lim Abdullah
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li Yoong Tang
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Department of Social and Prevention Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lourance Abdel Razzaq Al Hadid
- Nursing Department, Princess Aisha Bint Al Hussein College of Nursing and Health Sciences, Al Hussein Bin Talal University, Ma'an, Jordan
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Higgins A, Murphy R, Downes C, Barry J, Monahan M, Hevey D, Kroll T, Doyle L, Gibbons P. Factors impacting the implementation of a psychoeducation intervention within the mental health system: a multisite study using the consolidation framework for implementation research. BMC Health Serv Res 2020; 20:1023. [PMID: 33168003 PMCID: PMC7654573 DOI: 10.1186/s12913-020-05852-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical. METHODS The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n = 75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. RESULTS Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. Important factors in the outer setting domain included structural stability within national systems and the peer payment system, while the extent of a recovery-oriented culture, leadership, implementation readiness, and buy-in were influential factors in the inner setting. The characteristics of the intervention in terms of design, evidence-base and adaptability also shaped the intervention's implementation as did the knowledge, beliefs and self-efficacy of facilitators. In terms of processes, implementation was influenced by the degree of engagement of key individuals who championed and supported the programme. The results highlight that while some of the barriers were specific to the programme, many reflected systemic and structural challenges within health services more generally. CONCLUSION Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation.
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Affiliation(s)
- Agnes Higgins
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - Rebecca Murphy
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
- Department of Psychology, Maynooth University, Kiladre, Ireland
| | - Carmel Downes
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - Jennifer Barry
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - Mark Monahan
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Louise Doyle
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
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Hsiao CY, Lu HL, Tsai YF. Factors associated with family functioning among people with a diagnosis of schizophrenia and primary family caregivers. J Psychiatr Ment Health Nurs 2020; 27:572-583. [PMID: 31991512 DOI: 10.1111/jpm.12608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Families act not only as the primary support for people with a diagnosis of schizophrenia but also as partners in the healthcare system. Families who have members with mental disorders, particularly schizophrenia, experience challenges in family functioning. Research on families in relation to schizophrenia primarily focuses on the determinants that affect family functioning from primary family caregivers' perspectives. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This report provides evidence that there is a concordance between family functioning and inpatient psychiatric rehabilitation facilities for the patient-caregiver dyad; both care-receivers and primary family caregivers considered family functioning as poor. Care-receivers with lower education levels, increased number of previous hospitalizations and poor quality of family-centred care experienced unhealthy family functioning. Primary family caregivers and care-receivers with higher education levels, lower suicidality and greater quality of family-centred care experienced healthier family functioning. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Understanding the degree of family functioning, particularly its concordance and correlates as perceived by patients and primary family caregivers, may serve as a platform for inculcating assessment of family functioning to achieve holistic patient care. Open dialogue in family-focused care planning is essential to facilitate collaborative partnerships and improve family functioning among people with a diagnosis of schizophrenia and their primary family caregivers. Further research on culturally relevant, evidence-based family interventions to enhance the functioning of affected families is warranted, especially for families with members in inpatient psychiatric rehabilitation facilities. ABSTRACT: Introduction Families provide frontline caregiving support for people with a diagnosis of schizophrenia. However, research primarily addresses correlates of family functioning from primary family caregivers' perspectives. Aim To examine perceived family functioning, particularly its concordance within patient-caregiver dyads and associated factors in families of people living with schizophrenia. Methods A cross-sectional, descriptive correlational design was used. A total of 133 dyads of patients and primary family caregivers from inpatient psychiatric rehabilitation services participated. Descriptive statistics, independent-sample t test, one-way ANOVA, Pearson's correlation coefficients, intraclass correlation coefficient and stepwise multiple linear regression analyses were applied. Results Family functioning was perceived as impaired by patient-caregiver dyads, and there existed a concordance in this regard. Patients' and family caregivers' education levels, patients' suicidality, number of previous hospitalizations and quality of family-centred care correlated with patients' and primary family caregivers' family functioning. Discussion Findings highlight the importance of patient- and family-reported family functioning with implications to address individual and collective concerns. Implications for Practice Evidence-based family interventions are crucial for assisting vulnerable families in promoting family functioning. Mental health nurses should facilitate collaboration and open dialogue concerning perspectives of patients and families to improve delivery of comprehensive mental health care.
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Affiliation(s)
- Chiu-Yueh Hsiao
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan, Republic of China.,Department of Psychiatry, Chang Gung Memorial Hospital, Tao-Yuan City, Taiwan, Republic of China
| | - Huei-Lan Lu
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan, Republic of China
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan, Republic of China.,Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan, Republic of China.,Department of Psychiatry, Chang Gung Memorial Hospital in Keelung, Keelung City, Taiwan, Republic of China
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Al-Sawafi A, Lovell K, Renwick L, Husain N. Psychosocial family interventions for relatives of people living with psychotic disorders in the Arab world: systematic review. BMC Psychiatry 2020; 20:413. [PMID: 32819316 PMCID: PMC7441715 DOI: 10.1186/s12888-020-02816-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/12/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Family interventions in schizophrenia are evidence based and have been adapted to different cultural settings to improve their effectiveness and acceptability. The Arab world has a unique set of socio-cultural norms and values that cannot be ignored when developing or implementing such interventions. There is a lack of research on the feasibility of delivering family interventions for schizophrenia in the Arab region. The aim of this review is to synthesise the available evidence about culturally-adapted psychosocial family interventions in the Arab world. The review identifies the content and characteristics of these interventions, determines the strategies used to adapt them to Arab culture successfully, assesses the feasibility and acceptability of the interventions, and evaluates the effectiveness of these interventions for service users and their families. METHOD Five electronic databases were searched including MEDLINE, CINAHL, Cochrane Library, PsycINFO and EMBASE for articles written in Arabic and English from inception to August 2019. Data were extracted and synthesised narratively. RESULTS Six studies were retrieved from the search: three randomised control studies, two non-randomised studies and one qualitative study. There is limited evidence about culturally-adapted family interventions in the Arab region. However, the cultural adaptation process was comprehensive, and the implementation was reported to be feasible and acceptable. The methodological quality of the included studies was generally poor, so there is a risk of underestimating the effect size of the interventions due to lack of rigour and the presence of bias. CONCLUSION The present review provides the foundation for future work regarding family interventions in the Arab world, and confirms the feasibility of implementing such interventions with some modifications. Furthermore, the data suggests that any family-oriented intervention for schizophrenia is likely to be better than standard care in improving the outcome for patients and their families.
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Affiliation(s)
- Aziza Al-Sawafi
- Division of Nursing Midwifery & Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, College of Nursing/ Sultan Qaboos University of Manchester, Jean McFarlane Building Room 3.33 Oxford Road, Manchester, M13 9PL UK
| | - Karina Lovell
- Mental Health in the Division of Nursing, Midwifery & Social Work, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Laoise Renwick
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Nusrat Husain
- Division of Psychology & Mental Health, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
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Hasan AAH, Jaber AA. The effect of a family intervention on primary caregivers psychological outcomes: Findings from the integrative literature review. Perspect Psychiatr Care 2019; 55:277-290. [PMID: 30604874 DOI: 10.1111/ppc.12339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 11/09/2018] [Indexed: 01/09/2023] Open
Abstract
AIMS This literature review examines the effectiveness of the family interventions (FIs) targeted at the primary caregivers of people diagnosed with schizophrenia on improving the knowledge level of schizophrenia and health-related outcomes. METHODS A total of nine studies were reviewed from December 1999 to May 2017. The methods described by the Center for Reviews and Dissemination were used to guide this review. RESULTS The FIs showed consistent improvement in the knowledge level of schizophrenia among participants for various follow-up intervals. In addition, FIs were found to be superior to treatment as usual in influencing health-related outcomes. CONCLUSIONS Implications of the findings for mental healthcare practice to include primary caregivers with the patient in the treatment process.
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Affiliation(s)
- Abd Al-Hadi Hasan
- Nursing Department, Fakeeh College for Medical Sciences, Mental Health Nursing, Jeddah, Saudi Arabia
| | - Ala Abu Jaber
- Nursing Department, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
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Hasan AA, Tumah H. Determinants of quality of life among people diagnosed with schizophrenia at outpatient clinics. Perspect Psychiatr Care 2019; 55:30-39. [PMID: 29645261 DOI: 10.1111/ppc.12278] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/26/2018] [Accepted: 03/06/2018] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The study examines the determinants of the quality of life (QoL) among outpatients with schizophrenia in Jordan. DESIGN AND METHODS A cross-sectional study design was used with 157 people with schizophrenia treated in outpatient clinics. Demographic, clinical and psychosocial variables were examined for their influence on QoL. Data were analysed with descriptive statistics, Pearson product moment correlation and stepwise forward multiple linear regression. FINDINGS The majority of the study participants were female, single, unemployed, had secondary level of education or less and were being supported financially by family members. QoL correlated negatively with advanced age, male gender, longer duration of illness, high body mass index and prescribed typical anti-psychotic medication. However, it was correlated positively with employment and being married. Illness duration, recurrent hospitalisation, knowledge level about schizophrenia, psychiatric symptoms and coping mechanisms were found to be key significant predictors of QoL among participants. PRACTICAL IMPLICATIONS The study findings enhance our understanding of socio-demographic, clinical and psychosocial characteristics influencing the QoL in people with schizophrenia. Involvement of families in the management process may improve patients' ability to be integrated in the community and be more socially active.
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Affiliation(s)
- Abd Alhadi Hasan
- Fakeeh College for Medical Sciences, Alhamra District, Palestine Street, Jeddah, Saudi Arabia
| | - Hussein Tumah
- Fakeeh College for Medical Sciences, Alhamra District, Palestine Street, Jeddah, Saudi Arabia
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Hasan AAH. The correlation between the quality of life and clinical variables among outpatients with schizophrenia. Psychiatry Res 2019; 271:39-45. [PMID: 30465980 DOI: 10.1016/j.psychres.2018.09.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 05/08/2018] [Accepted: 09/28/2018] [Indexed: 01/09/2023]
Abstract
The study identifies the correlation between the quality of life (QoL) among outpatients with schizophrenia and clinical outcomes. A cross-sectional study design was used with 157 people with schizophrenia treated in outpatient clinics. Demographic, clinical and psychosocial variables were examined for their influence on QoL. Data were analysed with descriptive statistics, Pearson product moment correlation and stepwise forward multiple linear regression. The majority of the study participants were female, single, unemployed, had secondary level of education or less and were being supported financially by family members. QoL correlated negatively with advanced age, male gender, longer duration of illness, high body mass index and prescribed typical anti-psychotic medication. However, it was related positively with employment and being married. Illness duration, recurrent hospitalisation, knowledge level about schizophrenia, psychiatric symptoms and coping mechanisms were found to be key significant predictors of QoL among participants. The study findings enhance our understanding of socio-demographic, clinical and psychosocial characteristics influencing the QoL in people with schizophrenia. Involvement of families in the management process may improve patients' ability to be integrated in the community and be more socially active.
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Affiliation(s)
- Abd Al-Hadi Hasan
- Fakeeh College for Medical Sciences, Fakeeh College for Medical Science, 1222, Jeddah, Saudi Arabia.
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Abstract
PURPOSE OF REVIEW The aim was to synthesize recent evidence on schizophrenia illness experience and outcomes and models of care in low and middle-income countries (LMICs). RECENT FINDINGS There is a plurality of explanatory models for psychosis and increasing evidence that context influences experiences of stigma. People with schizophrenia in LMICs are vulnerable to food insecurity, violence and physical health problems, in addition to unmet needs for mental healthcare. Family support may help to improve outcomes if present, but caregivers may be overwhelmed by the challenges faced. Despite efforts to increase availability, evidence-based care remains inaccessible to many people with schizophrenia. Non-randomized evaluations in South Africa and Mexico indicate that psychosocial support groups for people with schizophrenia and caregivers may be acceptable and useful. Randomized controlled trials in Pakistan and China show that culturally adapted cognitive-behavioural therapy can reduce symptom severity. There is emerging evidence that alternative medicine, such as Tai Chi, may be beneficial, but to date most studies are of low quality. The challenges of biomedical-traditional provider collaborations have been highlighted. Evaluations of integrated mental healthcare in primary care are underway and promise to provide vital information about how to scale-up quality care. SUMMARY Acceptable and effective responses to schizophrenia in LMICs should be cognisant of both cultural context and universal concerns. Efforts to enhance the quality of family support should be central to models of care.
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Hasan AA, Musleh M. Barriers to Seeking Early Psychiatric Treatment amongst First-episode Psychosis Patients: A Qualitative Study. Issues Ment Health Nurs 2017; 38:669-677. [PMID: 28485998 DOI: 10.1080/01612840.2017.1317307] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS The aim of this study was to explore the family members' determinant of the delay in seeking psychiatric care to patients diagnosed with psychosis. METHODS Qualitative semi-structured interviews were carried out with twenty-seven family members of patients with psychosis at psychiatric outpatient clinics in Amman, Jordan. RESULTS The findings revealed that perceived stigma and fears about being labelled are the main barriers to requesting early psychiatric health care. The participants cited many different reasons linked to finding help led to delay in seeking help in the early stages of the illness including misattribution of the cause and symptoms of mental illness, family and financial factors. CONCLUSIONS The study highlights the importance of enhancing knowledge about the schizophrenia-related spectrum to ensure patients seek treatment in a more timely manner.
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Affiliation(s)
- Abd Alhadi Hasan
- a Nursing Department , Dr Soliman Fakeeh College of Nursing and Medical Sciences , Jeddah , Saudi Arabia
| | - Mahmoud Musleh
- b Nursing Department , Fakeeh College for Medical Sciences , Jeddah , Saudi Arabia
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Hasan AAH, Musleh M. Public Stigma Toward Mental Illness in Jordan: A Cross-Sectional Survey of Family Members of Individuals With Schizophrenia, Depression, and Anxiety. J Psychosoc Nurs Ment Health Serv 2017; 55:36-43. [DOI: 10.3928/02793695-20170519-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 04/07/2017] [Indexed: 01/03/2023]
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