1
|
Veloso Gomes P, Marques A, Pereira J, Pimenta R, Donga J, Simões de Almeida R. Using Immersive Environments in E-Mental Health Rehabilitation Programs Directed to Future Health Professionals to Promote Empathy and Health Literacy about Schizophrenia. Healthcare (Basel) 2024; 12:1550. [PMID: 39120253 PMCID: PMC11311649 DOI: 10.3390/healthcare12151550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/02/2024] [Accepted: 08/03/2024] [Indexed: 08/10/2024] Open
Abstract
Rehabilitation involves all types of patients, including people with schizophrenia. Schizophrenia is considered a complex syndrome characterized in general by fundamental and characteristic distortions of thinking and perception. The quality of life of a person with schizophrenia can be compromised by difficulty in carrying out their daily tasks and by the social stigma of their condition. The importance of training and sensitizing students in rehabilitation areas to this type of problem to improve the rehabilitation processes in which they will participate as future professionals involves empathy and the ability to communicate with these populations. It is possible through virtual reality to create immersive environments to simulate some psychotic symptoms characteristic of people with schizophrenia, such as visual hallucinations and hearing voices. The aim of this study was to test the effect of exposure to experiences characteristic of schizophrenia through two different types of immersive environments, graphical computational virtual reality and 360° video, on students from areas of social rehabilitation regarding empathy, social distance, and attitudes towards people with schizophrenia. Although the results were positive for the three parameters under study, no significant differences were found for each of them between the environments to which the participants were exposed. This study concluded that the choice between the two types of immersive environments should be based on the project's objectives, the target audience's needs, and available resources, rather than the type of environment itself, as their impact was similar.
Collapse
Affiliation(s)
- Paulo Veloso Gomes
- Laboratório de Reabilitação Psicossocial (LabRP), Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde (ESS), Polytechnic of Porto, 4200-072 Porto, Portugal; (A.M.); (R.S.d.A.)
| | - António Marques
- Laboratório de Reabilitação Psicossocial (LabRP), Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde (ESS), Polytechnic of Porto, 4200-072 Porto, Portugal; (A.M.); (R.S.d.A.)
| | - Javier Pereira
- CITIC Research Center, University of A Coruña, 15011 A Coruña, Spain;
| | - Rui Pimenta
- Associated Laboratory for Green Chemistry of the Network of Chemistry and Technology (LAQV-REQUIMTE), Escola Superior de Saúde (ESS), Polytechnic of Porto, 4200-072 Porto, Portugal;
- Center for Innovation in Biomedicine and Biotechnology (CIBB), Centro de Estudos de Investigação em Saúde da Universidade de Coimbra (CEISUC), 3004-512 Coimbra, Portugal
| | - João Donga
- Laboratório de Reabilitação Psicossocial (LabRP), Centro de Investigação em Reabilitação (CIR), Escola Superior de Media Artes e Design (ESMAD), Polytechnic of Porto, 4200-072 Porto, Portugal;
| | - Raquel Simões de Almeida
- Laboratório de Reabilitação Psicossocial (LabRP), Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde (ESS), Polytechnic of Porto, 4200-072 Porto, Portugal; (A.M.); (R.S.d.A.)
| |
Collapse
|
2
|
Goh YS, Ow Yong JQY, Ng CKV, Li Z, Hu Y, Tam WSW, Ho SHC. Caregivers' experiences in helping individuals with severe and enduring mental health challenges integrate into the community: A qualitative descriptive study in Singapore. J Psychiatr Ment Health Nurs 2024. [PMID: 38899596 DOI: 10.1111/jpm.13071] [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: 11/05/2023] [Revised: 05/05/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT Individuals with severe and enduring mental health challenges continued to consume mental health services for an average of 13 years as they needed multiple acute psychiatric admissions due to the challenges they experienced in their everyday activities. As caregivers of individuals with severe and enduring mental health challenges, they often bear the brunt of caregiving through their assistance with activities of daily living (ADL), providing emotional support and ensuring medication compliance for their loved ones. When caring for their loved ones, caregivers often reported psychological stress, social isolation and emotional exhaustion due to stressors such as uncertainty of the future, the lack of support from professional services and the isolation from their own social network and support mechanism. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Insights from this study revealed that caregivers for individuals with severe and enduring mental health challenges went through a lonely and exhausting journey fraught with psychological, physical, social and financial challenges, echoing the caregiving needs and the prevalence of the caregiver burden. WHAT ARE THE IMPLICATIONS FOR PRACTICE Insights shared by the caregivers demonstrated the need for a centralised point of contact to navigate Singapore's fragmented mental healthcare sector. Peer-support groups should be further promoted because they offer the benefits of information exchange, mutual support and a sense of empowerment and hopefulness, which may help ease the caregiver burden. Life skills training, such as teaching how to communicate empathetically with family members, resolve conflicts using open communication, maintain a structured daily routine and solve pragmatic problems in daily life, is more critical for individuals with severe and enduring mental health challenges. This will help them learn how to manage their well-being, live independently, and stabilise their conditions. Lastly, public awareness campaigns should honour caregivers by highlighting their strength, resilience, and dedication. The state can provide financial assistance in the form of tax relief for their income per annum or caregiver allowance to alleviate the financial stress that caregivers are facing. ABSTRACT Introduction The progressive deinstitutionalisation of mental healthcare has increasingly shifted care responsibilities from healthcare professionals to family caregivers for individuals with severe mental illness. Caregivers must balance many obligations, which often compromise their overall health and well-being, while helping their loved ones integrate into the community. Aim To identify and understand caregivers' needs and challenges as they help individuals with severe and enduring mental health challenges integrate into the community. Methods This study used a descriptive qualitative approach to explore the experiences and challenges of caregivers for individuals with severe and enduring mental health challenges when integrating back into the community. A semi-structured guide was used during the video-conferencing interviews conducted between December 2021 and November 2022. This study was reported according to the 32-item Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Findings Fourteen caregivers were individually interviewed by the primary author. Most caregivers were female, with an average of 15 years of experience caring for their loved ones. Using Braun and Clark's six-phase thematic framework, we inductively generate the themes and subthemes from the data. The two themes were (i) challenges (whose subthemes included personal challenges in caregiving, the lack of awareness, and stigma and employment) and (ii) support (whose subthemes included the importance of socialisation for individuals with mental health conditions, existing avenues of support and potential areas for support). Discussion Our findings informed the contemporary needs of caregivers caring for individuals with severe and enduring mental health challenges integrating into the community. Like the global challenges for people with mental health issues, psychosocial support and other supplementary support are still common themes in mental health settings. The findings further specifically highlighted the importance of accessible points of contact as resources and employment-enabling and sustaining initiatives to help manage caregivers' emotional and system challenges, which addresses the gaps identified in the findings. Caregivers' peer-support groups, life skills training and public mental health awareness are also necessitated by the caregivers' voices. Implications for Practice Priority areas include having a centralised point of contact within the community for caregivers. Government or not-for-profit organisations can take the lead by initiating employment-enabling initiatives for individuals with severe and enduring mental health challenges and their caregivers.
Collapse
Affiliation(s)
- Yong-Shian Goh
- Alice lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Jenna Qing Yun Ow Yong
- Alice lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | | | - Ziqiang Li
- Institute of Mental Health, Singapore City, Singapore
| | - Yanan Hu
- Alice lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Wai-San Wilson Tam
- Alice lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Su Hui Cyrus Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| |
Collapse
|
3
|
McQuillan MA, Wright M, Zechner MR, Di Prospero E, Karyczak S, Cimmino ML, Murphy AA. Physician Assistant Student Attitudes About People With Serious Mental Illness. J Physician Assist Educ 2024; 35:129-135. [PMID: 37991263 PMCID: PMC11101175 DOI: 10.1097/jpa.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
INTRODUCTION This study explored the attitudes of physician assistant (PA) students toward the future care of individuals with serious mental illness (SMI). Physician assistant student education offers a unique opportunity to confront and reduce bias toward individuals with SMI. However, no previous literature has documented PA student attitudes toward SMI. METHODS Preclinical students (n = 7) from a single PA program were invited to participate in 2 focus groups exploring attitudes toward the future care of patients with SMI. The focus groups lasted approximately 60 minutes and were conducted by non-PA faculty using a question guide. RESULTS Four themes emerged from interviews: perceptions about the population, knowledge of mental health conditions, approach to care, and program curriculum input. DISCUSSION Several themes aligned with the participant's level of training. Participants demonstrated didactic knowledge yet lacked clinical exposure to provide context. Future studies should focus on developing interactive learning techniques to prepare students for patients with SMI.
Collapse
Affiliation(s)
- Matthew A. McQuillan
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Matthew Wright
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Michelle R. Zechner
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Elizabeth Di Prospero
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Sean Karyczak
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Meredith L. Cimmino
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Ann A. Murphy
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| |
Collapse
|
4
|
Szekely R, Mason O, Frohlich D, Barley E. 'It's not everybody's snapshot. It's just an insight into that world': A qualitative study of multiple perspectives towards understanding the mental health experience and addressing stigma in healthcare students through virtual reality. Digit Health 2024; 10:20552076231223801. [PMID: 38188857 PMCID: PMC10768613 DOI: 10.1177/20552076231223801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024] Open
Abstract
Objective The resurgence of virtual reality (VR) technologies has led to their increased use in contemporary healthcare education. One promising application is simulating the experiences of individuals with mental health conditions (MHCs) to reduce stigma among future healthcare professionals. This study set out to explore what those impacted by, or involved in, the education of healthcare students think about using VR in this way. Methods One individual interview and five focus groups were conducted with healthcare students (n = 7), healthcare educators (n = 6), and lived experience experts (n = 5). Before sharing their perspectives, participants familiarised themselves with VR equipment and immersive materials simulating MHCs. The constant comparative method and thematic analysis were used to analyse the data. Results Participants recognised the acceptability and utility of VR for addressing mental health stigma in healthcare students, emphasising the immersive nature of this technology. However, some participants raised concerns about the limited insight VR could provide into the experiences of patients with the same MHCs and its potential emotional impact on users. Participants recommended the incorporation of interactive, realistic environments with a person-centred focus into future VR-based stigma reduction interventions while stressing the importance of providing healthcare students with opportunities for reflection and support. Conclusions Healthcare students, healthcare educators, and lived experience experts highlighted both advantages and barriers associated with using VR to understand the experience of patients with MHCs. Furthermore, the recommendations put forward can inform the design, content, and delivery of VR-based stigma reduction interventions in healthcare education.
Collapse
Affiliation(s)
- Raul Szekely
- School of Psychology, University of Surrey, Guildford, UK
| | - Oliver Mason
- School of Psychology, University of Surrey, Guildford, UK
| | - David Frohlich
- Digital World Research Centre, University of Surrey, Guildford, UK
| | | |
Collapse
|
5
|
Valdivia Ramos HN, Mora-Rios J, Natera G, Mondragón L. Psychometric properties of the Mexican version of the opening minds stigma scale for health care providers (OMS-HC). PeerJ 2023; 11:e16375. [PMID: 38025693 PMCID: PMC10655721 DOI: 10.7717/peerj.16375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Healthcare providers are one of the main groups that contribute to the stigmatization of people with mental disorders. Apathy, accusation, fatalism, and morbid curiosity are the most common forms of stigmatization encountered, and these are associated with inadequate treatment, reduced treatment adherence, decreased help-seeking behavior, an increased risk of relapse, and complications with other medical conditions. The aim of this study was to examine the psychometric properties of an adapted Spanish version of the Opening Minds Stigma Scale (OMS-HC) for healthcare providers in Mexico and identify certain stigmatizing attitudes within this group. Methods An ex-post facto cross-sectional observational study was conducted with 556 healthcare providers in Mexico, with an average age of 29.7 years, who were mostly women (80.4%). Validity was examined through confirmatory factor analysis. Differences according to gender, discipline, occupation, and educational level were analyzed using multivariate methods. Results The factor structure of the OMS-HC, consisting of three subscales identified by the original authors of the instrument (attitudes of healthcare providers towards people with mental illness, secrecy/help-seeking, and social distance), was confirmed. The model demonstrated good fit (x2/df = 2.36, RMSEA = 0.050, CFI = 0.970, TLI = 0.962, SRMR = 0.054, NFI = 0.950, PNFI = 0.742). Internal consistency was found to be adequate (α = 0.73, ω = 0.76) for the scale itself and slightly lower than acceptable for the subscales. Significant differences were found by discipline, educational level, and, for student providers, by academic semester. Higher scores were observed on the OMS-HC scale among nursing and medical professionals, undergraduate students, and those in early semesters. Conclusions The Spanish version of the OMS-HC has demonstrated adequate psychometric properties and could be a useful tool to facilitate research on this topic in Mexico, and to carry out comparative studies with healthcare personnel in other Spanish-speaking countries.
Collapse
Affiliation(s)
- Hugo Noel Valdivia Ramos
- Programa de Maestría y Doctorado de Ciencias Médicas, Ontológicas y de la Salud, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Jazmín Mora-Rios
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Guillermina Natera
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Liliana Mondragón
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| |
Collapse
|
6
|
Cunningham R, Imlach F, Every-Palmer S, Haitana T, Peterson D. Dealing With Discrimination in Physical Health Care Services: Strategies of People With Mental Health and Substance Use Conditions. J Patient Exp 2023; 10:23743735231211778. [PMID: 37928962 PMCID: PMC10623936 DOI: 10.1177/23743735231211778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Discrimination against people with mental health and substance use conditions (MHSUC) by health professionals contributes to the poor physical health outcomes this group experiences. We surveyed people with MHSUC in Aotearoa New Zealand to explore how they experienced and responded to discrimination from physical health services. Participants identified 6 strategies used to avoid or minimize the impact of discrimination. Avoidance strategies included not seeking help, not disclosing MHSUC diagnoses and changing or seeking out health professionals who did not behave in discriminatory ways. Minimizing strategies were being a "model patient," taking a support person to consultations or advocating for what they needed, even in the face of discrimination. Physical health services must focus on providing non-discriminatory care to reduce the need for compensatory strategies and improve care of physical illness for people with MHSUC.
Collapse
Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Fiona Imlach
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Tracy Haitana
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Debbie Peterson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| |
Collapse
|
7
|
Samuels T, Pretorius C. Healthcare providers' perspectives on stigma when working with people with functional seizures. Seizure 2023; 112:121-127. [PMID: 37820427 DOI: 10.1016/j.seizure.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/22/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE This study aimed to explore healthcare providers' (HCPs) perspectives and experiences of stigma when working with people with Functional Seizures (FS). Particular focus was given to understanding HCPs' experience and knowledge of FS, discovering the attitudes held by HCPs towards working with FS as a mental health condition, and exploring HCPs' views of how their stigma manifests towards people with FS when in an occupational setting. METHODS Semi-structured individual interviews were conducted with thirteen HCPs who specialised in the diagnosis and/or treatment and management of FS. A reflexive thematic analysis was utilised to analyse the semi-structured interviews for means of identifying themes within the data. RESULTS Themes identified included those of contextual factors which indirectly influence stigma, inclusive of a lack of time and resources. HCPs additionally described having a general limited understanding of FS as a condition and becoming frustrated with their patients, which in turn fuelled a stigmatising culture. HCPs also pointed to the idea of diagnostic terms being inappropriate and adding to stigma. HCPs' personal stigma as well as institutionalised stigma were identified. The HCPs also reported on the negative attitudes and actions directed towards FS patients. Strategies to reduce stigma were also explored. CONCLUSION There are various ways in which HCPs' stigma towards individuals with FS can occur, both directly and indirectly. HCPs play a key role in supporting their FS patients and alleviating the effects of stigma; thus, it is important to understand their perspectives and experiences through further research.
Collapse
Affiliation(s)
- Tresan Samuels
- Stellenbosch University, Department of Psychology, Private Bag X1, Matieland, Stellenbosch
| | - Chrisma Pretorius
- Stellenbosch University, Department of Psychology, Private Bag X1, Matieland, Stellenbosch.
| |
Collapse
|
8
|
Cunningham R, Imlach F, Haitana T, Every-Palmer S, Lacey C, Lockett H, Peterson D. It's not in my head: a qualitative analysis of experiences of discrimination in people with mental health and substance use conditions seeking physical healthcare. Front Psychiatry 2023; 14:1285431. [PMID: 37908598 PMCID: PMC10613695 DOI: 10.3389/fpsyt.2023.1285431] [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: 08/30/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Clinician bias contributes to lower quality healthcare and poorer health outcomes in people with mental health and substance use conditions (MHSUC). Discrimination can lead to physical conditions being overlooked (diagnostic overshadowing) or substandard treatment being offered to people with MHSUC. This research aimed to utilise experiences of people with MHSUC to identify discrimination by clinicians, including the role of clinician's beliefs and assumptions in physical health service provision. Methods We surveyed people with MHSUC who accessed physical healthcare services. Of 354 eligible participants, 253 responded to open-ended questions about experiences of those services. Thematic descriptive analysis of survey responses was completed using existing stigma frameworks and inductive coding. Results One dominant theme from survey responses was that diagnostic overshadowing by clinicians was driven by clinician mistrust. Another theme was that clinicians assumed respondent's physical symptoms, including pain, were caused by MHSUC. This influenced decisions not to initiate investigations or treatment. Respondents perceived that clinicians focused on mental health over physical health, contributing to suboptimal care. Discussion Discrimination based on MHSUC leads to poor quality care. Health systems and clinicians need to focus quality improvement processes on access to and delivery of equitable physical healthcare to people with MHSUC, address stereotypes about people with MHSUC and improve integration of mental and physical healthcare.
Collapse
Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Fiona Imlach
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Tracy Haitana
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Helen Lockett
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Debbie Peterson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| |
Collapse
|
9
|
Goh YSS, Ow Yong JQY, Li AZ. Effectiveness of Illness Management and Recovery program on people with severe mental illnesses: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1162288. [PMID: 37255686 PMCID: PMC10225549 DOI: 10.3389/fpsyt.2023.1162288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/19/2023] [Indexed: 06/01/2023] Open
Abstract
Background The Illness Management and Recovery (IMR) program has been established in response to the challenges faced by people with severe mental illnesses (SMIs). The program emphasizes the self-management of mental health conditions and the achievement of personally meaningful goals. However, reviews on its efficacy remain scarce, especially in recent years. Objective This review aimed to examine the efficacy of IMR in improving personal-recovery outcomes among people with SMIs. Methods A search was conducted on seven databases (CINAHL, Embase, ProQuest, PsycINFO, PubMed, Scopus, and Web of Science) from inception to February 2022, without limits on the dates and types of publications. Studies were included if they had examined the efficacy of IMR in one or more outcomes, investigated at least one group of participants, and been published in English. The participants were adults (at least 16 years of age) with a formal diagnosis of at least one SMI. Results Fourteen studies were included in this review, and eight outcomes were examined: personal recovery, global functioning, social functioning, hope, perceived social support, quality of life, substance abuse, and knowledge of mental illness. There is limited evidence on the superiority of IMR to existing treatment plans or other interventions in improving the outcomes of interest among people with SMIs. However, the low attendance rates in many included studies suggest the presence of a threshold of exposure to IMR beyond which its treatment effects could be observed. Suggestions for future IMR implementation are discussed. Conclusions The IMR program may serve as an alternative or complementary intervention for people with SMIs, especially with enhanced program exposure and access to resource materials. Systematic review registration https://inplasy.com/inplasy-2022-10-0005/.
Collapse
Affiliation(s)
- Yong Shian Shawn Goh
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Jenna Qing Yun Ow Yong
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Amy Ziqiang Li
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
- Institute of Mental Health, Singapore, Singapore
| |
Collapse
|
10
|
Crapanzano KA, Deweese S, Pham D, Le T, Hammarlund R. The Role of Bias in Clinical Decision-Making of People with Serious Mental Illness and Medical Co-morbidities: a Scoping Review. J Behav Health Serv Res 2023; 50:236-262. [PMID: 36720760 PMCID: PMC10016362 DOI: 10.1007/s11414-022-09829-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 02/02/2023]
Abstract
The aim of this review was to examine the evidence for the impact of explicit and implicit biases against mental illness on the clinical decision-making of primary care physicians, medical students, and nurses when they are providing care to individuals with serious mental illness for cardiovascular disease, diabetes, and cancer. Studies were identified by searching MEDLINE, EBSCO host, and PsychINFO. A total of 18 studies published between 1996 and 2020 were reviewed and summarized. The studies were divided into two groups-studies that used a simulation or vignette methodology and those with a qualitative approach (interviews and focus groups). Of the simulation/vignette studies that allowed participants to report what they would have done in various clinical scenarios, there were roughly equal numbers of neutral or negative clinical decisions that represented 80% of the relevant behavioral results. Only 21% of the findings demonstrated a clinical decision that was favorable towards people with mental illness. Of the qualitative studies, all of the studies reported behaviors (either self-reported or observed) that were likely to be biased against people with mental illness, while 3 of the studies reported mixed results. Healthcare provider bias against individuals with mental illness does exist and impacts clinical decisions negatively. Much more empirical work needs to be done to determine the full extent and impact of the problem, including how these decisions affect the lives of individuals with mental illness.
Collapse
Affiliation(s)
- Kathleen A Crapanzano
- Department of Psychiatry, LSU School of Medicine, 5246 Brittany Drive, Rm 340, Baton Rouge, Baton Rouge, LA, 70808, USA.
| | - Stephen Deweese
- Department of Psychiatry, LSU School of Medicine, 5246 Brittany Drive, Rm 340, Baton Rouge, Baton Rouge, LA, 70808, USA
| | - Diem Pham
- Department of Psychiatry, LSU School of Medicine, 5246 Brittany Drive, Rm 340, Baton Rouge, Baton Rouge, LA, 70808, USA
| | - Thanh Le
- Department of Psychiatry, LSU School of Medicine, 5246 Brittany Drive, Rm 340, Baton Rouge, Baton Rouge, LA, 70808, USA
| | - Rebecca Hammarlund
- Department of Psychiatry, LSU School of Medicine, 5246 Brittany Drive, Rm 340, Baton Rouge, Baton Rouge, LA, 70808, USA
| |
Collapse
|
11
|
Hallyburton A, Allison-Jones L. Mental health bias in physical care: An integrative review of the literature. J Psychiatr Ment Health Nurs 2023. [PMID: 36740727 DOI: 10.1111/jpm.12911] [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: 02/04/2022] [Revised: 12/01/2022] [Accepted: 02/01/2023] [Indexed: 02/07/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Individuals experiencing mental illness make up a significant portion of the world's population. Individuals with mental illness experience higher rates of morbidity and die on average at least a decade earlier than individuals without mental health disorders. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Issues of stigma, diagnostic overshadowing, premature closure, inadequate workup, fear and lack of training negatively impact the care of individuals with mental illness. Issues impacting the care of individuals experiencing mental illness cross geographic and care setting boundaries. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Partnerships between physical and mental health practitioners are needed to thoroughly assess and accurately diagnose symptoms experienced by individuals with mental illness. Educational interventions can help prepare practitioners to care for individuals with mental illness. Nurses can better advocate for effective patient care by learning about the phenomenon of diagnostic overshadowing and calling attention to its occurrence. ABSTRACT: Introduction Individuals with mental illness experience significantly higher overall rates of morbidity and mortality than counterparts without mental illness. Misdiagnosis of symptoms emanating from physical illnesses as psychiatric in nature presents one important cause. Aim This integrative review explores research on healthcare professionals' misattribution of physical health symptoms to patients' comorbid psychiatric issues and seeks to identify unifying themes, shared causes, and possible strategies for addressing the issue. Method This review uses Whittemore and Knafl's 2005 integrative review methodology coupled with vetted quality appraisal tools. Results Following a systematic search of allied health, medical, psychological, sociological and general literature, 24 publications employing qualitative, quantitative, mixed and synthesis research methodologies were selected. Each study was appraised according to design, and relevant data were extracted. Discussion Themes of stigmatization, diagnostic overshadowing, incomplete medical examination, insufficient training, and fears experienced by providers and patients emerged. Implications for Practice Increased partnering between physical and mental health practitioners, continuing education, and improving patient-provider communication are key to providing equitable care. Nurses play primary roles in empathizing with patients, advocating for appropriate care and educating others on the dangers of misattributing physical symptoms to psychiatric cause.
Collapse
Affiliation(s)
- Ann Hallyburton
- Hunter Library, Western Carolina University, Cullowhee, North Carolina, USA.,Department of Public Health and Healthcare Leadership, Radford University Carilion, Roanoke, Virginia, USA
| | - Lisa Allison-Jones
- Department of Public Health and Healthcare Leadership, Radford University Carilion, Roanoke, Virginia, USA
| |
Collapse
|
12
|
Zechner MR, Singhal V, Murphy AA, York J, Karyczak S, Muhammad A. Dental pre‐doctoral student perceptions about serious mental illness: Concerns and role clarification. J Dent Educ 2022; 87:639-645. [DOI: 10.1002/jdd.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Michelle R. Zechner
- Department of Psychiatric Rehabilitation and Counseling Professions Rutgers School of Health Professions Piscataway New Jersey USA
| | - Vaishali Singhal
- Department of Community Health, Rutgers School of Dental Medicine and Department of Interdisciplinary StudiesRutgers School of Health Professions NewarkNew JerseyUSA
| | - Ann A. Murphy
- Department of Psychiatric Rehabilitation and Counseling Professions Rutgers School of Health Professions Piscataway New Jersey USA
| | - Jill York
- Department of Community Health Rutgers School of Dental Medicine Newark New Jersey USA
| | - Sean Karyczak
- Department of Psychiatric Rehabilitation and Counseling Professions Rutgers School of Health Professions Piscataway New Jersey USA
| | - Asiyah Muhammad
- Rutgers School of Environmental and Biological Sciences with a major in Biological Sciences and a minor in Health and Society New Brunswick New Jersey USA
| |
Collapse
|
13
|
Gunasekaran S, Tan GTH, Shahwan S, Goh CMJ, Ong WJ, Subramaniam M. The perspectives of healthcare professionals in mental health settings on stigma and recovery - A qualitative inquiry. BMC Health Serv Res 2022; 22:888. [PMID: 35804378 PMCID: PMC9270770 DOI: 10.1186/s12913-022-08248-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health stigma is one of the most prominent barriers to recovery, and it is widely known that stigma may manifest differentially in different cultures. Healthcare professionals working closely with persons with mental illnesses (PMI) may provide important insights towards stigma that are otherwise unattainable from caregivers and consumers. However, there is a dearth of literature on healthcare professionals' perspectives on this topic. Thus, this study uses a multilevel approach to explore how stigma affects recovery from the perspectives of healthcare professionals that work closely with PMI in Singapore. METHODS Semi-structured interviews were conducted with a total of 17 healthcare professionals who were working in mental health settings in Singapore. Participants were recruited via direct email invitation or through snowball sampling. Data collected was analysed with the inductive thematic analysis method. All coding and inter-rater analyses were performed with NVivo. RESULTS The current study themes identified stigma-related factors that influence PMI's recovery from the perspectives of healthcare professionals working closely with PMI. These factors were organised into three overarching themes in a multilevel structure. The three themes were classified as Micro Factors (e.g., internalised stigma), Meso Factors (e.g., discrimination of people associated with the stigmatised group), and Macro Factors (e.g., structural stigma and stigma within healthcare settings). CONCLUSIONS The findings of this study gave us a greater understanding of how stigma influences recovery in Singapore, which could be used to guide the development and implementation of future policies and strategies to promote recovery. Importantly, our results suggest that improving mental health literacy, addressing cultural misgivings towards mental illness, implementing recovery-oriented practices, and making insurance more accessible for PMI could mitigate the deleterious impact that stigma has on recovery.
Collapse
Affiliation(s)
- Savita Gunasekaran
- Research Division, Institute of Mental Health, 10 Buangkok View, 539747, Singapore, Singapore.
| | - Gregory Tee Hng Tan
- Research Division, Institute of Mental Health, 10 Buangkok View, 539747, Singapore, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, 10 Buangkok View, 539747, Singapore, Singapore
| | - Chong Min Janrius Goh
- Research Division, Institute of Mental Health, 10 Buangkok View, 539747, Singapore, Singapore
| | - Wei Jie Ong
- Research Division, Institute of Mental Health, 10 Buangkok View, 539747, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, 539747, Singapore, Singapore
| |
Collapse
|
14
|
Clients' Perspectives Regarding Peer Support Providers' Roles and Support for Client Access to and Use of Publicly Funded Mental Health Programs Serving Transition-Age Youth in Two Southern California Counties. J Behav Health Serv Res 2022; 49:364-384. [PMID: 35237904 PMCID: PMC9160087 DOI: 10.1007/s11414-022-09792-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/04/2022]
Abstract
Peer providers are increasingly used by mental health programs to engage transition age youth (TAY, age 16-24) living with serious mental illness. This study elicited TAY clients’ perspectives on peer providers’ roles, responsibilities, and contribution to TAYs’ use of mental health services. In 2019, six focus groups were conducted with TAY clients (n=24) receiving publicly funded mental health services in Southern California. Results from this analysis included four themes that illustrated the role of peers as perceived by TAY clients, including: 1) building client–peer provider relationships, 2) engaging with mental health services, 3) role-modelling recovery and supporting skill acquisition to instill hope and empowerment, and 4) peer roles and experiences specific to racial/ethnic concordance. These findings provide needed perspectives on the evolving role of peer providers in mental health services programming for TAY clients.
Collapse
|
15
|
Kam JA, Mendez Murillo R, Cornejo M, Mendoza N. The Importance of Norms and Efficacy in Predicting Undocumented College Students' Intentions to Talk to an On-Campus Mental Health Professional. HEALTH COMMUNICATION 2022; 37:230-241. [PMID: 33089721 DOI: 10.1080/10410236.2020.1834208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Drawing from an extended version of a focus theory of normative conduct, the extended parallel process model, and self-stigma, this study examined factors that predict undocumented college students' (UCS) intentions to talk to an on-campus mental health professional (MHP). Two hundred thirty-seven UCS completed an online survey between January-June, 2019. Structural equation modeling analyses revealed that the more UCS believed their friends talked to an on-campus MHP (i.e., descriptive norms), the more likely UCS were to believe that talking to an on-campus MHP would help them manage their undocumented-related stress (i.e., response efficacy). In turn, UCS were more likely to report intentions to talk to an on-campus MHP. Furthermore, family injunctive norms were positively associated with self-efficacy and communication efficacy, and in turn, intentions to talk to an on-campus MHP. Unexpectedly, friend injunctive norms were not significantly associated with the three types of efficacy or intentions. Lastly, although family and friend injunctive norms were negatively associated with self-stigma, self-stigma was not significantly associated with intentions to talk to an on-campus MHP. This study's findings emphasize the importance of addressing different types of norms and efficacy when attempting to reduce UCS' under-utilization of on-campus mental health services.
Collapse
Affiliation(s)
| | | | | | - Nicole Mendoza
- School of Communication and Information, Rutgers University
| |
Collapse
|
16
|
Wang K, Zhang A, Cuevas AG, De Fries CM, Hinton L, Falcón LM. The Association Between Post-Traumatic Stress and Depressive Symptoms Among Older Puerto Ricans in Boston: How Does Loneliness Matter? J Aging Health 2021; 34:786-793. [PMID: 34949131 DOI: 10.1177/08982643211064123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the association between post-traumatic stress and depression and whether such an association differs by level of loneliness among older Puerto Ricans. METHODS Data were collected from 304 Puerto Ricans aged 60 and above living in the Greater Boston area who responded to questionnaires. We used ordinary least squares regression to examine the association between post-traumatic stress, loneliness, and depressive symptoms. RESULTS Post-traumatic stress was significantly associated with higher levels of depression. The association between post-traumatic stress and depression was stronger for those experiencing a higher degree of loneliness. DISCUSSION In working with older Puerto Ricans experiencing post-traumatic stress, it is important for mental health professionals to incorporate the assessment of loneliness and to prevent and reduce comorbid depression by addressing loneliness through improving social skills, enhancing social support, and reducing maladaptive social cognition.
Collapse
Affiliation(s)
- Kaipeng Wang
- Graduate School of Social Work, 2927University of Denver, CO, USA
| | - Anao Zhang
- School of Social Work, 1259University of Michigan, Ann Arbor, MI, USA
| | - Adolfo G Cuevas
- Department of Community Health, 1810Tufts University, Medford, MA, USA
| | | | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, 8789University of California Davis, CA, USA
| | - Luis M Falcón
- College of Fine Arts, Humanities, and Social Sciences, 14710University of Massachusetts Lowell, MA, USA
| |
Collapse
|
17
|
Molloy R, Brand G, Munro I, Pope N. Seeing the complete picture: A systematic review of mental health consumer and health professional experiences of diagnostic overshadowing. J Clin Nurs 2021; 32:1662-1673. [PMID: 34873769 DOI: 10.1111/jocn.16151] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/20/2021] [Accepted: 11/16/2021] [Indexed: 12/16/2022]
Abstract
AIM To systematically identify, explore and synthesise qualitative data related to mental health consumer and health professional experiences of diagnostic overshadowing. BACKGROUND Mental health consumers experience significantly high rates of physical illness, poorer health outcomes and are more likely to die prematurely of physical illnesses than the general population. Diagnostic overshadowing is a complex and life-threatening phenomenon that occurs when physical symptoms reported by mental health consumers are misattributed to mental disorders by health professionals. This typically occurs in general healthcare settings. METHODS Drawing on JBI methodology for systematic reviews, four scholarly databases and grey literature was searched, followed by eligibility screening and quality assessment using JBI QARI frameworks, resulting in six studies for inclusion. Findings were synthesised using meta-aggregation. The PRISMA checklist was adhered to throughout this process. FINDINGS Five synthesised findings emerged. Three from the health professional experience: working in ill-suited healthcare systems, missing the complete diagnostic picture, and misunderstanding the lived experience of mental illness. Two from the mental health consumer experience: not knowing if the cause is physical or mental, and surviving and ill-suited health care system. CONCLUSIONS Diagnostic overshadowing is a multidimensional experience of interconnecting factors including systematic healthcare system issues, health professionals limited mental health knowledge and skills, stigmatic attitudes and mental health consumers miscommunicating their physical healthcare needs. Further research is needed to make diagnostic overshadowing visible and mitigate against this phenomenon that deprives mental health consumers of equitable access to quality healthcare. RELEVANCE TO CLINICAL PRACTICE Those who govern healthcare systems have an obligation to recognise and address the unique needs of mental health consumers who seek help for physical illnesses to ensure they receive quality and safe care. Forming collaborative partnerships with mental health consumers in the development of knowledge translation initiatives targeting healthcare policy, practice and education are urgently required.
Collapse
Affiliation(s)
- Renee Molloy
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Gabrielle Brand
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Ian Munro
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Nicole Pope
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.,The Western Australian Group for Evidence Informed Healthcare Practice: A JBI Centre of Excellence, Perth, Western Australia, Australia
| |
Collapse
|
18
|
Ojeda VD, Munson MR, Jones N, Berliant E, Gilmer TP. The Availability of Peer Support and Disparities in Outpatient Mental Health Service Use Among Minority Youth with Serious Mental Illness. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:290-298. [PMID: 32728991 PMCID: PMC7870605 DOI: 10.1007/s10488-020-01073-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We examine whether the availability of peer support reduces disparities in service use among minority youth ages 16-24 with serious mental illness in Los Angeles and San Diego Counties. Administrative data from 2015-2018 was used to summarize service use among 13,363 transition age youth age 16-24 with serious mental illness who received services from 183 outpatient public mental health programs; 17.2% were Black, 67.4% were Latinx, and 15.4% were non-Latinx white. The availability of peer support was assessed via a program survey. Generalized linear models were used to assess the relationship between availability of peer support, defined as having a peer specialist on staff, and the annual number of outpatient mental health visits. We also examined the relationship between racial/ethnic concordance of youth and peer specialists and use of outpatient services. Forty-six percent of youth received services from programs that employed peer specialists. Among youth in both counties, the availability of peer support was associated with an increase in annual outpatient visits (P ≤ .05 each). Peer support was associated with reductions in service use disparities among Black and Latinx youth in Los Angeles County (P < .001 each). Peer concordance was associated with an increase in outpatient service use among Latinx youth in both counties (P < .05 each). Peer support was associated with increases in use of outpatient mental health services. Detailed examination of the context for youth peer support implementation is merited to identify the specific pathways that improve outcomes.
Collapse
Affiliation(s)
- Victoria D. Ojeda
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | | | - Nev Jones
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Emily Berliant
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - Todd P. Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| |
Collapse
|
19
|
Kohn L, Christiaens W, Detraux J, De Lepeleire J, De Hert M, Gillain B, Delaunoit B, Savoye I, Mistiaen P, Jespers V. Barriers to Somatic Health Care for Persons With Severe Mental Illness in Belgium: A Qualitative Study of Patients' and Healthcare Professionals' Perspectives. Front Psychiatry 2021; 12:798530. [PMID: 35153863 PMCID: PMC8825501 DOI: 10.3389/fpsyt.2021.798530] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A huge and still growing mortality gap between people with severe mental illness (SMI) and the general population exists. Physical illnesses, mainly cardiovascular diseases, substantially contribute to the high mortality rates in patients with SMI. Disparities in somatic health care access, utilisation, and provision contribute to these poor physical health outcomes. METHODS A qualitative study, using semi-structured interviews, was set up to explore SMI patients' and healthcare professionals' perspectives on somatic health care in different psychiatric settings of the three Belgian regions (Flanders, Brussels, Wallonia). Interviews were digitally recorded and transcribed prior to qualitative inductive thematic analysis, using Nvivo software. The COnsolidated criteria for REporting Qualitative research (COREQ) were used for reporting methods and findings. RESULTS Collaboration and information flows between psychiatric healthcare professionals, non-psychiatric healthcare professionals, and persons with SMI were troublesome. This seemed to be mainly due to stigma and prejudice and challenging communication and data transfer. Lack of sufficient training and experience to identify and treat somatic health problems in people with SMI (for psychiatrists and psychiatric nurses) and lack of psychiatric knowledge and feeling or sensitivity for psychiatric patients (for non-psychiatric healthcare professionals) further complicated adequate somatic health care. Finally, optimal somatic follow-up of patients with SMI was hampered by organisational problems (unavailability of equipment, unadapted infrastructure, understaffing, hospital pharmacy issues, and insufficient health promotion/lifestyle interventions), patient-related issues (unawareness of physical problems, non-adherence, need for accompaniment) and financial barriers. CONCLUSION There is an urgent need for integrated somatic and mental healthcare systems and a cultural change. Psychiatrists and primary care providers continue to consider the mental and physical health of their patients as mutually exclusive responsibilities due to a lack of sufficient training and experience, poor or absent liaison links, time constraints and organisational and financial barriers. Modifying these aspects will improve the quality of somatic health care for these vulnerable patients.
Collapse
Affiliation(s)
- Laurence Kohn
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - Johan Detraux
- Department of Neurosciences, Public Health Psychiatry, University Psychiatric Center, Catholic University of Leuven, Kortenberg, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, Catholic University of Leuven, Leuven, Belgium
| | - Marc De Hert
- Department of Neurosciences, Center for Clinical Psychiatry, University Psychiatric Center, Catholic University of Leuven, Kortenberg, Belgium.,Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Benoit Gillain
- Société Royale de Santé Mentale de Belgique, Ottignies, Belgium
| | | | | | | | - Vicky Jespers
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| |
Collapse
|
20
|
Gedik MM, Partlak Günüşen N, Çelik Ince S. Experiences of individuals with severe mental illnesses about physical health services: A qualitative study. Arch Psychiatr Nurs 2020; 34:237-243. [PMID: 32828355 DOI: 10.1016/j.apnu.2020.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 01/17/2023]
Abstract
AIM This study aims to understand the ideas and experiences of individuals' with severe mental illnesses regarding their access to physical health care services. METHODS In this study, a qualitative descriptive approach and content analysis were used. The sample comprised 14 individuals with severe mental illnesses in a psychiatric clinic. RESULTS Three themes emerged: i) a barrier theme related to the patient and the illness, health care professionals, and the health system; ii) a theme that comprised facilitators, for example, health care system facilitators and family support; and iii) an expectations theme, comprising patients' and health care services. CONCLUSION Individuals with severe mental illnesses must overcome many barriers while receiving physical health care, and nursing interventions are critical for increasing these patients' access to physical health services.
Collapse
Affiliation(s)
- Mukaddes Müberra Gedik
- Health Sciences Institute, Psychiatric Nursing Program, Dokuz Eylul University, 35340 Izmir, Turkey
| | | | - Sevecen Çelik Ince
- Psychiatric Nursing Department, Zonguldak Bülent Ecevit University, 67600 Zonguldak, Turkey.
| |
Collapse
|