1
|
Winkler K, Lincoln TM, Wiesjahn M, Jung E, Schlier B. How does loneliness interact with positive, negative and depressive symptoms of psychosis? New insights from a longitudinal therapy process study. Schizophr Res 2024; 271:179-185. [PMID: 39032430 DOI: 10.1016/j.schres.2024.07.024] [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: 11/22/2023] [Revised: 06/19/2024] [Accepted: 07/07/2024] [Indexed: 07/23/2024]
Abstract
Cross-sectional research suggests an association between loneliness and psychotic symptoms, but the causal direction of this association is still unclear. Even though loneliness has been proposed as a potential treatment target to improve psychotherapy for psychosis, not much is known about its role in the treatment process. In this study, we re-analyzed data from a therapy process study to investigate the temporal dynamics between loneliness and psychotic symptoms throughout therapy and to explore whether state-of-the-art CBT for psychosis (CBTp) decreases loneliness. Over the course of up to 45 weekly sessions of CBTp, 57 patients reported their feelings of loneliness and current positive, negative and depressive symptom levels at each session. Multilevel regression revealed a reduction in all symptoms over time, but no reduction in loneliness. Time-lagged multilevel regression showed that loneliness predicted subsequent negative and depressive symptoms, whereas positive symptom levels predicted subsequent loneliness. Thus, changes in loneliness seem to be both cause and consequence of psychotic symptom changes. These findings highlight the importance of loneliness as a treatment target, particularly in patients with negative symptoms and depression. Future research should address loneliness-specific interventions as an augmentation of state-of-the-art CBTp.
Collapse
Affiliation(s)
- Katharina Winkler
- Universität Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Tania M Lincoln
- Universität Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Martin Wiesjahn
- Philipps-University Marburg, Department of Psychology, Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Esther Jung
- Philipps-University Marburg, Department of Psychology, Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Björn Schlier
- Universität Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany; University of Wuppertal, Institute of Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Gaußstraße 20, 42119 Wuppertal, Germany
| |
Collapse
|
2
|
Hennemann S, Kuhn S, Witthöft M, Jungmann SM. Diagnostic Performance of an App-Based Symptom Checker in Mental Disorders: Comparative Study in Psychotherapy Outpatients. JMIR Ment Health 2022; 9:e32832. [PMID: 35099395 PMCID: PMC8844983 DOI: 10.2196/32832] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/09/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Digital technologies have become a common starting point for health-related information-seeking. Web- or app-based symptom checkers aim to provide rapid and accurate condition suggestions and triage advice but have not yet been investigated for mental disorders in routine health care settings. OBJECTIVE This study aims to test the diagnostic performance of a widely available symptom checker in the context of formal diagnosis of mental disorders when compared with therapists' diagnoses based on structured clinical interviews. METHODS Adult patients from an outpatient psychotherapy clinic used the app-based symptom checker Ada-check your health (ADA; Ada Health GmbH) at intake. Accuracy was assessed as the agreement of the first and 1 of the first 5 condition suggestions of ADA with at least one of the interview-based therapist diagnoses. In addition, sensitivity, specificity, and interrater reliabilities (Gwet first-order agreement coefficient [AC1]) were calculated for the 3 most prevalent disorder categories. Self-reported usability (assessed using the System Usability Scale) and acceptance of ADA (assessed using an adapted feedback questionnaire) were evaluated. RESULTS A total of 49 patients (30/49, 61% women; mean age 33.41, SD 12.79 years) were included in this study. Across all patients, the interview-based diagnoses matched ADA's first condition suggestion in 51% (25/49; 95% CI 37.5-64.4) of cases and 1 of the first 5 condition suggestions in 69% (34/49; 95% CI 55.4-80.6) of cases. Within the main disorder categories, the accuracy of ADA's first condition suggestion was 0.82 for somatoform and associated disorders, 0.65 for affective disorders, and 0.53 for anxiety disorders. Interrater reliabilities ranged from low (AC1=0.15 for anxiety disorders) to good (AC1=0.76 for somatoform and associated disorders). The usability of ADA was rated as high in the System Usability Scale (mean 81.51, SD 11.82, score range 0-100). Approximately 71% (35/49) of participants would have preferred a face-to-face over an app-based diagnostic. CONCLUSIONS Overall, our findings suggest that a widely available symptom checker used in the formal diagnosis of mental disorders could provide clinicians with a list of condition suggestions with moderate-to-good accuracy. However, diagnostic performance was heterogeneous between disorder categories and included low interrater reliability. Although symptom checkers have some potential to complement the diagnostic process as a screening tool, the diagnostic performance should be tested in larger samples and in comparison with further diagnostic instruments.
Collapse
Affiliation(s)
- Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Sebastian Kuhn
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Stefanie M Jungmann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| |
Collapse
|
3
|
Abstract
People of BAMME (Black, Asian, Minority, and Migrant ethnic) heritage in the UK experience various anomalies when engaging with mental health services. Typically concentrated at secondary and secure levels of care, these discrepant experiences interact with a reticence to uptake mental health support at the primary care level. Official, national anti-stigma campaigns often reproduce messages that do not connect with BAMME communities, raising questions about how best to challenge stigma in this context. This research paper describes a case study of an alternative means to address stigma, drawing from a dramatic comedy performance, Plant Fetish, written and performed by an artist who carries a diagnosis of complex post-traumatic stress disorder (Complex PTSD). The study comprised of an individual interview with the artist, audience feedback, and a group discussion conducted after the show. Data were subject to interpretative phenomenological analysis. Findings are discussed in relation to the importance of using creativity to increase public awareness of mental health and inform efforts to reduce stigma. We conclude that such approaches show promise and merit further exploration in a context of growing discursive interest in mental health amidst acknowledged deficiencies of contemporary anti-stigma efforts, especially as they apply to BAMME people, their families, and their communities.
Collapse
|
4
|
Kulnik ST, Halter M, Hilton A, Baron A, Garner S, Jarman H, Klaassen B, Oliver E. Confidence and willingness among laypersons in the UK to act in a head injury situation: a qualitative focus group study. BMJ Open 2019; 9:e033531. [PMID: 31690611 PMCID: PMC6858168 DOI: 10.1136/bmjopen-2019-033531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore factors influencing confidence and willingness among laypersons in the UK to act in a head injury situation, in order to inform first aid education offered by the British Red Cross. DESIGN Qualitative focus group study. SETTING South East England. PARTICIPANTS Forty-four laypersons (37 women, 7 men) were purposively recruited from the general public using snowball sampling, into one focus group each for six population groups: parents of young children (n=8), informal carers of older adults (n=7), school staff (n=7), sports coaches (n=2), young adults (n=9) and 'other' adults (n=11). The median (range) age group across the sample was 25-34 years (18-24, 84-95). Participants were from Asian (n=6), Black (n=6), Mixed (n=2) and White (n=30) ethnic backgrounds. RESULTS The majority of participants described being confident and willing to act in a head injury scenario if that meant calling for assistance, but did not feel sufficiently confident or knowledgeable to assist or make decisions in a more involved way. Individuals' confidence and willingness presented as fluid and dependent on an interplay of situational and contextual considerations, which strongly impacted decision-making: prior knowledge and experience, characteristics of the injured person, un/observed head injury, and location and environment. These considerations may be framed as enablers or barriers to helping behaviour, impacting decision-making to the same extent as-or even more so than-the clinical signs and symptoms of head injury. An individual conceptual model is proposed to illustrate inter-relationships between these factors. CONCLUSIONS Our findings show that confidence and willingness to act in a head injury scenario are dependent on several contextual and situational factors. It is important to address such factors, in addition to knowledge of clinical signs and symptoms, in first aid education and training to improve confidence and willingness to act.
Collapse
Affiliation(s)
- Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Ann Hilton
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Aidan Baron
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | | | - Heather Jarman
- Emergency Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Barry Klaassen
- British Red Cross, London, UK
- Ninewells Hospital and Medical School, Dundee, UK
| | | |
Collapse
|
5
|
Abstract
OBJECTIVE To explore lay understanding and perceptions of schizophrenia in university students. DESIGN Qualitative study using semi-structured interviews and thematic analysis. SETTING The University of Birmingham, West Midlands. PARTICIPANTS 20 UK home students of white British (n=5), Indian (n=5), Pakistani (n=5), African Caribbean (n=4) and dual white British and African Caribbean ethnicity (n=1). RESULTS Findings revealed a lack of knowledge about schizophrenia, particularly the negative symptoms that were not mentioned. There were mixed ideas on the causes and sources of available help for schizophrenia; however, positively many said they would consult their general practitioner. While there was a general misconception among the students that schizophrenia caused multiple personalities and was a dangerous illness, there were some differences in perceptions and understanding between ethnic groups, with more Indian students perceiving upbringing as a causal factor in the development of the illness and more Pakistani students perceiving possession by a spirit as a cause. CONCLUSIONS The university students interviewed lacked knowledge about schizophrenia and stigma was widespread, both of which may delay help-seeking. Public health campaigns educating young people about schizophrenia are required to improve early identification and intervention and improve outcomes. Further research exploring ways to effectively tackle stigma is also required.
Collapse
Affiliation(s)
- Charlotte Cadge
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Charlotte Connor
- Mental Health and Wellbeing, University of Warwick Warwick Medical School, Coventry, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| |
Collapse
|
6
|
Wang J, Wydell TN, Zhang L, Quan W, Tian J, Liu J, Dong W. The underlying mechanism of deficits of speech comprehension and hallucinations in Chinese patients with schizophrenia. J Psychiatr Res 2018; 97:16-21. [PMID: 29161608 DOI: 10.1016/j.jpsychires.2017.10.020] [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: 06/28/2017] [Revised: 10/20/2017] [Accepted: 10/31/2017] [Indexed: 11/28/2022]
Abstract
Sentence context and fundamental frequency (F0) contours are important factors to speech perception and comprehension. In Chinese-Mandarin, lexical tones can be distinguished by the F0 contours. Previous studies found healthy people could use the cue of context to recover the phonological representations of lexical tones from the altered tonal patterns to comprehend the sentences in quiet condition, but can not in noise environment. Lots of research showed that patients with schizophrenia have deficits of speech perception and comprehension. However, it is unclear how context and F0 contours influence speech perception and comprehension in patients with schizophrenia. This study detected the contribution of context and lexical tone to sentence comprehension in four types of sentences by manipulating the context and F0 contours in 32 patients with schizophrenia and 33 healthy controls. The results showed that (1) in patients with schizophrenia, the interaction between context and F0 contour was not significant, which was significant in healthy controls; (2) the scores of sentences with two types of sentences with flattened F0 contours were negatively correlated with hallucination trait scores; (3) the patients with schizophrenia showed significantly lower scores on the intelligibility of sentences in all conditions, which were negatively correlated with PANSS-P. The patients with schizophrenia couldn't use the cue of context to recover the phonological representations of lexical tones from the altered tonal patterns when they comprehend the sentences, inner noise may be the underlying mechanism for the deficits of speech perception and comprehension.
Collapse
Affiliation(s)
- Jiuju Wang
- Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Taeko N Wydell
- Centre for Cognition and Neuroimaging, Brunel University London, Uxbridge, UK
| | - Linjun Zhang
- College of Chinese Studies, Beijing Language and Culture University, Beijing 100083, China
| | - Wenxiang Quan
- Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Ju Tian
- Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Jin Liu
- Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Wentian Dong
- Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China.
| |
Collapse
|
7
|
Wang J, Liu Q, Wydell TN, Liao J, Wang F, Quan W, Tian J, Wang P, Liu J, Dong W. Electrophysiological basis of reading related phonological impairment in Chinese speakers with schizophrenia: An ERP study. Psychiatry Res Neuroimaging 2017; 261:65-71. [PMID: 28131010 DOI: 10.1016/j.pscychresns.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 11/30/2022]
Abstract
It has been reported in alphabetic languages that individuals with schizophrenia showed language-related cognitive impairments including phonological deficits, which were in turn associated with clinical symptoms such as auditory hallucinations and thought disorders. To date, however, the phonological deficits involved in schizophrenia in Chinese and its neural basis have not been well established. In order to establish such a relationship we conducted a behavioral study using lexical tone judgment and digit span tasks as well as an event-related potential (ERP) study with an auditory oddball paradigm, in particular, for P300 effects, the event-related brain potential (ERP) index of discrimination. Chinese patients with schizophrenia and Chinese healthy controls in China participated in the current study. Compared to the healthy controls, the patients with schizophrenia showed significant impairments in phonological processing skills, which in turn significantly correlated with smaller P300 effects. Thus these behavioral and electrophysiological findings in Chinese patients with schizophrenia were critically evaluated in terms of their phonological processing abilities.
Collapse
Affiliation(s)
- Jiuju Wang
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Qi Liu
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Taeko N Wydell
- Centre for Cognition and Neuroimaging, Brunel University London, Uxbridge, UK
| | - Jinmin Liao
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Fang Wang
- Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Wenxiang Quan
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Ju Tian
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Pengfei Wang
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Jin Liu
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Wentian Dong
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China.
| |
Collapse
|
8
|
Taylor CJ, Hobbs FDR, Marshall T, Leyva-Leon F, Gale N. From breathless to failure: symptom onset and diagnostic meaning in patients with heart failure-a qualitative study. BMJ Open 2017; 7:e013648. [PMID: 28283487 PMCID: PMC5353318 DOI: 10.1136/bmjopen-2016-013648] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To explore 2 key points in the heart failure diagnostic pathway-symptom onset and diagnostic meaning-from the patient perspective. DESIGN Qualitative interview study. SETTING Participants were recruited from a secondary care clinic in central England following referral from primary care. PARTICIPANTS Over age 55 years with a recent (<1 year) diagnosis of heart failure confirmed by a cardiologist following initial presentation to primary care. METHODS Semistructured interviews were carried out with 16 participants (11 men and 5 women, median age 78.5 years) in their own homes. Data were audio-recorded and transcribed. Participants were asked to describe their diagnostic journey from when they first noticed something wrong up to and including the point of diagnosis. Data were analysed using the framework method. RESULTS Participants initially normalised symptoms and only sought medical help when daily activities were affected. Failure to realise that anything was wrong led to a delay in help-seeking. Participants' understanding of the term 'heart failure' was variable and 1 participant did not know he had the condition. The term itself caused great anxiety initially but participants learnt to cope with and accept their diagnosis over time. CONCLUSIONS Greater public awareness of symptoms and adequate explanation of 'heart failure' as a diagnostic label, or reconsideration of its use, are potential areas of service improvement.
Collapse
Affiliation(s)
- C J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F D R Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - T Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - F Leyva-Leon
- Aston Medical Research Insitutue, Aston Medical School, Birmingham, UK
| | - N Gale
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| |
Collapse
|
9
|
Wang J, Wang P, Xia Z, Liu J, Quan W, Tian J, Wydell TN, Dong W. Lexical and sub-lexical reading skills and their correlation to clinical symptoms in young Chinese patients with schizophrenia. Psychiatry Res 2015; 230:919-23. [PMID: 26611156 DOI: 10.1016/j.psychres.2015.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 11/06/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
Patients with schizophrenia often experience severe reading deficits such as oral reading and reading comprehension deficits. However, it is not known whether different types of lexical or sub-lexical components in reading are also impaired. In order to address this issue, the present study had 22 young Chinese patients with schizophrenia and 22 young Chinese normal controls undergo a battery of reading tests, which specifically measures lexical and sub-lexical components of reading in Chinese. The schizophrenic group further underwent Brief Psychiatric Rating Scale (BPRS) in order to ascertain the severity of patients' clinical symptoms. The results showed that compared to the controls, (1) the schizophrenic patients performed significantly poorly in orthographic processing, orthography-phonology mapping, and orthography-semantic mapping tests and further that (2) their performances in orthographic processing, and orthography-semantic mapping skill tests negatively correlated with the BPRS score. Note however that their ability to access their mental lexicon was intact. There is thus a clear need for studies with a larger sample-size and neurobiological measures which would lead to our better understanding of the behavioral as well as the neural relationships between schizophrenic patients, and their reading processing impairments, thus developing effective reading intervention programs for the schizophrenic patients.
Collapse
Affiliation(s)
- Jiuju Wang
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Pengfei Wang
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Zhichao Xia
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
| | - Jin Liu
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Wenxiang Quan
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Ju Tian
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Taeko N Wydell
- Centre for Cognition and Neuroimaging, Brunel University London, Uxbridge, UK
| | - Wentian Dong
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China.
| |
Collapse
|
10
|
Sweeney S, Air T, Zannettino L, Galletly C. Psychosis, Socioeconomic Disadvantage, and Health Service Use in South Australia: Findings from the Second Australian National Survey of Psychosis. Front Public Health 2015; 3:259. [PMID: 26636059 PMCID: PMC4653578 DOI: 10.3389/fpubh.2015.00259] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/04/2015] [Indexed: 11/25/2022] Open
Abstract
The association between mental illness and poor physical health and socioeconomic outcomes has been well established. In the twenty-first century, the challenge of how mental illnesses, such as psychosis, are managed in the provision of public health services remains complex. Developing effective clinical mental health support and interventions for individuals requires a coordinated and robust mental health system supported by social as well as health policy that places a priority on addressing socioeconomic disadvantage in mental health cohorts. This paper, thus, examines the complex relationship between socioeconomic disadvantage, family/social supports, physical health, and health service utilization in a community sample of 402 participants diagnosed with psychosis. The paper utilizes quantitative data collected from the 2010 Survey of High Impact Psychosis research project conducted in a socioeconomically disadvantaged region of Adelaide, SA, Australia. Participants (42% female) provided information about socioeconomic status, education, employment, physical health, contact with family and friends, and health service utilization. The paper highlights that socioeconomic disadvantage is related to increased self-reported use of emergency departments, decreased use of general practitioners for mental health reasons, higher body mass index, less family contact, and less social support. In particular, the paper explores the multifaceted relationship between socioeconomic disadvantage and poor health confronting individuals with psychosis, highlighting the complex link between socioeconomic disadvantage and poor health. It emphasizes that mental health service usage for those with higher levels of socioeconomic disadvantage differs from those experiencing lower levels of socioeconomic disadvantage. The paper also stresses that the development of health policy and practice that seeks to redress the socioeconomic and health inequalities created by this disadvantage be an important focus for mental health services. Such health policy would provide accessible treatment programs and linked pathways to illness recovery and diminish the pressure on the delivery of health services. Consequently, the development of policy and practice that seeks to redress the socioeconomic and health inequalities created by disadvantage should be an important focus for the improvement of mental health services.
Collapse
Affiliation(s)
- Shaun Sweeney
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Tracy Air
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Lana Zannettino
- School of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
11
|
Raffard S, Bortolon C, Macgregor A, Norton J, Boulenger JP, El Haj M, Capdevielle D. Cognitive insight in schizophrenia patients and their biological parents: a pilot study. Schizophr Res 2014; 159:471-7. [PMID: 25242359 DOI: 10.1016/j.schres.2014.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/04/2014] [Accepted: 08/30/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical insight in schizophrenia patients is partly associated with familial environment but has been poorly studied to date. We aimed to explore (1) the relationship between parents' cognitive insight and their offspring's; (2) the relationship between parents' cognitive insight and their clinical insight into the disease of their offspring; and (3) the clinical and cognitive determinants of cognitive insight in parents. METHODS Cognitive insight was assessed in 37 patient-biological parent pairs/dyads with the Beck Cognitive Insight Scale (BCIS). Other measures included the Scale to assess Unawareness of Mental Disorder and cognitive assessments. RESULTS We found no significant association between parents' cognitive insight and their offspring's. Conversely, a positive association between parents' cognitive insight and parents' insight into their offspring's symptoms was found. Better awareness of their offspring's specific symptoms was associated with lower levels of overconfidence in one's beliefs and with BCIS total score. BCIS Self-Certainty and BCIS total score were associated with better executive functioning and verbal comprehension. CONCLUSIONS Better insight into their offspring's symptoms is associated with cognitive insight in biological parents of schizophrenia patients. Our results support the integration of cognitive intervention targeting parents' cognitive flexibility in family psychoeducational programs and provide an important first step towards developing a more refined understanding of the factors involved in insight into symptoms of illness in parents of schizophrenia patients.
Collapse
Affiliation(s)
- Stéphane Raffard
- Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, University of Montpellier 3, Montpellier, France; University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, France.
| | - Catherine Bortolon
- Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, University of Montpellier 3, Montpellier, France; University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, France
| | - Alexandra Macgregor
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, France
| | - Joanna Norton
- Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, University of Montpellier 3, Montpellier, France
| | - Jean-Philippe Boulenger
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, France
| | - Mohamad El Haj
- Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, University of Montpellier 3, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, France; INSERM U-1061, Montpellier, France; University Montpellier 1, Montpellier, France
| |
Collapse
|