Health status and treatment-seeking stigma in older adults with trauma and posttraumatic stress disorder

Burn self-stigma: A hybrid concept analysis

AIM

As burn self-stigma has not been addressed fully, the purpose of current study is to analyze dimensions of the concept using literature and lived experiences in burn survivors.

METHODS

Using hybrid concept analysis method, we investigated self-stigma in three phases (i.e. theoretical, fieldwork, and final analytical phase). In the first phase we reviewed the literature using PubMed, SCOPUS, Web of Science, Cochrane Library, OVID, SID and Google Scholar. Thirteen semi-structured interviews with burn survivors were conducted during the fieldwork phase. Two extra interviews with health care providers were undertaken for the aim of data triangulation. Textual content analysis and inductive content analysis were used to analyze the data of the first and second phases of this study, respectively. The findings of both phases were combined in the final analytical phase and a comprehensive definition was emerged.

RESULTS

We assigned all our findings into three content areas (i.e. antecedents, properties and consequences), which are dimensions of self-stigma. In final analytical phase antecedent, properties and consequences of the concept were formed in one (society's misconception about burns), three (negative definition of self, emotional responses, and behavioral responses), and three (negative individual effects, negative social effects, and negative familial effects) categories, respectively. Based on these categories and their corresponding subcategories, a comprehensive definition of the concept was presented.

CONCLUSION

Burn self-stigma is a state in which burn survivors experience unfavorable thoughts and feelings about themselves as a result of society's misconceptions about them. They give emotional and behavioral responses that define them in a negative way. In the end, the burn survivor's individual, familial, and social dimensions are significantly impacted.

Dog training as a complementary intervention to support Veteran mental health and well-being: A scoping review

BACKGROUND

Military veterans in the United States face a number of complex issues and barriers to successful civilian reintegration. Dog training programs offered to these individuals are being used as a complementary intervention to support multiple aspects of veteran reintegration. This scoping review explored the existing literature on dog training programs as a support for veteran mental health and well-being.

METHODS

A scoping review was conducted in accordance with PRISMA guidelines to analyze the existing research on this topic.

RESULTS

Five overarching themes were identified, including improvements to mental health, social benefits, a developed sense of purpose, differing impacts of training methods, and potential negative outcomes associated with stressful demands of training.

CONCLUSION

The results of this review suggested dog training programs have potentially positive effects on veteran mental health but also revealed a few potential negative impacts and the need for further research on this animal-assisted intervention.

Practice Considerations for Trauma-Informed Care at End of Life

Trauma is widespread, and its symptoms can adversely impact wellbeing at end of life, a time when hospice seeks to maximize quality of life. This article reviews research on trauma at end of life, provides an overview of trauma-informed principles, and explores possibilities for applying trauma-informed care through an illustrative case study of a patient at end of life. The case discussion applies findings from the literature using Feldman's Stepwise Psychosocial Palliative Care model as a roadmap. As shown in the case study, trauma-related symptoms may complicate care, making it an important subject of clinical attention for interdisciplinary hospice team members. As part of this team, social workers are particularly well suited to provide more targeted interventions where indicated, though all members of the team should take a trauma-informed approach. Lastly, this article reflects on the need for organizations to take a systems-level approach when implementing trauma-informed care and suggests implications for practice through a universal approach to trauma and the need for trauma-specific assessments and interventions at end-of-life, along with areas for future research.

Pilot randomized controlled trial of exercise training for older veterans with PTSD

Exercise training positively impacts mental health, yet remains untested in older adults with posttraumatic stress disorder (PTSD). We conducted a randomized controlled pilot trial to test the feasibility and acceptability of exercise training in older veterans with PTSD. Fifty-four veterans ≥ 60 years, with a DSM-V diagnosis of PTSD, were randomized to supervised exercise (n = 36) or wait-list (WL; n = 18). Primary outcomes included recruitment rates, attendance, satisfaction, and retention. Secondary outcomes included changes in PTSD symptoms, depression, health-related quality of life, and sleep quality; assessed at baseline and 12 weeks. There were no adverse events. Attrition was minimal (14%), and adherence to the exercise intervention was high (82%). Clinically significant improvements in PTSD and related conditions were observed following exercise (Cohen's d = 0.36-0.81). Exercise training is safe and acceptable in older adults with PTSD, may improve PTSD symptoms, and broadly impacts PTSD-related conditions. Future definitive trials are warranted.

The relationship between depression and sexual health service utilization among men who have sex with men (MSM) in Côte d'Ivoire, West Africa

BACKGROUND

In Cote D'Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression.

METHODS

1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d'Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment.

RESULTS

Depression (aOR:1.40, 95% CI: 1.07-1.84), being aged 25-29 years (aOR:1.84, 95% CI: 1.11-3.03),unemployed (aOR:0.64, 95% CI: 0.42-0.98), being a student (aOR:0.67, 95% CI: 0.48-0.96), being identified as male (aOR:0.44, 95% CI: 0.29-0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56-0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03-2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not.

CONCLUSION

Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D'Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d'Ivoire.

Self-stigma in PTSD: Prevalence and correlates

Self-stigma is the internalization of negative societal stereotypes about those with mental illnesses. While self-stigma has been carefully characterized in severe mental disorders, like schizophrenia, the field has yet to examine the prevalence and correlates of self-stigma in post-traumatic stress disorder (PTSD). Thus, we assessed self-stigma in veterans diagnosed with PTSD and compared with veterans with schizophrenia. We further examined associations between PTSD, depressive symptoms and self-stigma in the PTSD sample. Data came from two larger studies of people with PTSD (n = 46) and schizophrenia-spectrum disorders (n = 82). All participants completed the Internalized Stigma of Mental Illness Scale (ISMIS). Results revealed that people with schizophrenia report more experiences of discrimination as a result of stigma than do those with PTSD, but these diagnostic groups did not differ for other subscales. In the PTSD group, feelings of alienation positively correlated with PTSD and depressive symptoms; other subscales positively correlated with depressive symptoms only. Taken together, results suggest a significant level of self-stigma exists among veterans with PTSD, and that self-stigma has an effect on PTSD and commonly comorbid symptoms, like depression. Future work should investigate whether current self-stigma interventions for other groups could be applicable for those with PTSD.

Self-Stigma Experiences Among Older Adults with Mental Health Problems Residing in Long-Term Care Facilities: A Qualitative Study

Self-stigma is linked with a variety of deleterious consequences for the stigmatised individual. Much of the past research on self-stigma focuses on younger adults; however, little is known about the self-stigma experience among institutionalised older adults with mental health problems. This study aims to explore experiences of self-stigma among older adults with mental health problems in long-term care facilities. Ten semi-structured interviews were conducted. Insight into mental illness was identified as having a key influence upon the self-stigma experiences among this group. Participants shared common understandings, views, and behavioural reactions towards mental health problems. Lacking control, public stigma, sympathy, disinterest, avoidance, and fear were key themes among them. Re-conceptualising self-stigma theories and implementing interventions that aim at reducing stigmatising attitudes among this group are essential.