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Huang LT, Liu YL, Pao CH, Chang YH, Chu RY, Hsu HM, Wei DR, Yang CY. The association of social support and hope with self-stigma and perceived recovery among people with schizophrenia: The serial mediation effect. J Adv Nurs 2024; 80:2340-2350. [PMID: 38018027 DOI: 10.1111/jan.15980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND It is essential to assist individuals with a mental illness who have achieved clinical recovery in their personal recovery. Understanding the relationship between self-stigma and social support and the effects on perceived recovery can be valuable for clinical professionals in helping patients lead meaningful lives. AIM To examine the serial mediating roles of social support and perceived hope in self-stigma and the effects on perceived recovery. DESIGN A cross-sectional study. METHODS The study was conducted from September 2019 to June 2020. One hundred and fifty-seven patients with schizophrenia in seven chronic rehabilitation wards were enrolled. Each patient had a Positive and Negative Syndrome Scale score ≤ 60 points, and they regularly participated in occupational rehabilitation. Research tools included demographic data, the Internalized Stigma of Mental Illness Scale (ISMIS), Multidimensional Scale of Perceived Social Support (MSPSS), Herth Hope Index (HHI), and Perceived Recovery Inventory (PRI). IBM SPSS 24.0 was used to analyse the data. Pearson correlation was used to analyse the relationships between variables, and models 4 and 6 of PROCESS macro V3.4 for SPSS were used to examine the mediation model. RESULTS The results indicated that self-stigma and perceived recovery in patients with schizophrenia are negatively correlated, that peer support and perceived hope mediate the relationship between them, and that peer support and perceived hope also have a statistically significant serial mediating effect. CONCLUSION The serial mediation effect of peer support and perceived hope on the relationship between self-stigma and perceived recovery was statistically significant in this study. IMPACT This research delves into strategies to assist psychiatric patients in reducing self-stigma and achieving recovery. The findings underscore the heightened significance of peer support for patients in rehabilitative wards and offer valuable insights for medical staff. REPORTING METHOD STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Li Ting Huang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya Ling Liu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Che Hao Pao
- Yuanshan and Suao Branch, Taipei Veterans General Hospital, Yilan, Taiwan
| | - Yu Ho Chang
- Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ru Ying Chu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui Min Hsu
- Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Dia Ru Wei
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chiu Yueh Yang
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Agarwal D, Bailie CR, Rana S, Balan L, Grills NJ, Mathias K. Scaling a group intervention to promote caregiver mental health in Uttarakhand, India: A mixed-methods implementation study. Glob Ment Health (Camb) 2023; 10:e85. [PMID: 38161744 PMCID: PMC10755371 DOI: 10.1017/gmh.2023.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024] Open
Abstract
Caregivers are integral to health and social care systems in South Asian countries yet are themselves at higher risk of mental illness. Interventions to support caregiver mental health developed in high-income contexts may be contextually inappropriate in the Global South. In this mixed-methods study, we evaluated the implementation and scaling of a locally developed mental health group intervention for caregivers and others in Uttarakhand, India. We describe factors influencing implementation using the updated Consolidated Framework for Implementation Research, and selected implementation outcomes. Key influencing factors we found in common with other programs included: an intervention that was relevant and adaptable; family support and stigma operating in the outer setting; training and support for lay health worker providers, shared goals, and relationships with the community and the process of engaging with organisational leaders and service users within the inner setting. We identified further factors including the group delivery format, competing responsibilities for caregivers and opportunities associated with the partnership delivery model as influencing outcomes. Implementation successfully reached target communities however attrition of 20% of participants highlights the potential for improving outcomes by harnessing enablers and addressing barriers. Findings will inform others implementing group mental health and caregiver interventions in South Asia.
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Affiliation(s)
- Disha Agarwal
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Christopher R. Bailie
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Samson Rana
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Laxman Balan
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Nathan J. Grills
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kaaren Mathias
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
- Te Kaupeka Oranga, University of Canterbury, Christchurch, New Zealand
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Yu H, Sun YJ, Qin MN, Ren JX, Yu K, Song J, Zhou YQ, Liu L. Perception of risk of relapse among patients with first episode and recurrent schizophrenia: a descriptive phenomenological study. BMC Psychiatry 2023; 23:582. [PMID: 37563579 PMCID: PMC10413637 DOI: 10.1186/s12888-023-05023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Patients suffering from schizophrenia are at a higher risk of relapse. The perception of the risk of relapse in patients is critical for relapse prevention. In the field of psychiatry, the study of risk perception of relapse has been neglected. METHODS We carried out a qualitative study using a descriptive phenomenological approach. Data were collected at two psychiatric hospitals in China. In total, 22 patients with schizophrenia were recruited through purposive sampling. Face to face semi-structured in-depth interviews were conducted. Interview recordings were transcribed by the research team, and transcripts were analysed by two independent coders with Colaizzi's descriptive analysis framework. The consolidated criteria for reporting qualitative research checklist were used for reporting. RESULTS The data of first-episode patients yielded three themes: (i) lack of knowledge about disease recognition and medical treatment; (ii) overoptimistic estimation of the risk of relapse; (iii) perceived importance of treatment. For first-relapse patients : (i) initial awareness of relapse warning signs; (ii) lack of systematic and accurate assessment of disease information; (iii) the perception that drug withdrawal is related to relapse. Patients with multiple relapses: (i) susceptibility to relapse: confusion and powerlessness; (ii) the severity of relapse: suicidal thoughts and behavior; (iii) effects of perceived benefits and barriers of medication behaviour. CONCLUSIONS In schizophrenic patients with first-episode, first-relapse, and multiple relapses, there were dynamic changes in the perception of disease relapse risk and medication behaviour. Medical workers must improve risk awareness education. They should provide patients with scientific, accurate, and timely communication channels, and dynamically assess and manage the risk of relapse in various patients.
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Affiliation(s)
- Hong Yu
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Yu-Jing Sun
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Meng-Nan Qin
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Jia-Xin Ren
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Kai Yu
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Jin Song
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
| | - Yu-Qiu Zhou
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China.
| | - Li Liu
- Department of Nursing, Harbin Medical University Daqing Campus, Heilongjiang, 163319, Daqing, China
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Bailie CR, Pillai PS, Goodwin Singh A, Leishman J, Grills NJ, Mathias K. Does the Nae Umeed group intervention improve mental health and social participation? A pre-post study in Uttarakhand, India. Glob Ment Health (Camb) 2023; 10:e47. [PMID: 37854393 PMCID: PMC10579688 DOI: 10.1017/gmh.2023.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/21/2023] [Accepted: 07/19/2023] [Indexed: 10/20/2023] Open
Abstract
There are few evidence-based interventions to support caregiver mental health developed for low- and middle-income countries. Nae Umeed is a community-based group intervention developed with collaboratively with local community health workers in Uttarakhand, India primarily to promote mental wellbeing for caregivers and others. This pre-post study aimed to evaluate whether Nae Umeed improved mental health and social participation for people with mental distress, including caregivers. The intervention consisted of 14 structured group sessions facilitated by community health workers. Among 115 adult participants, 20% were caregivers and 80% were people with disability and other vulnerable community members; 62% had no formal education and 92% were female. Substantial and statistically significant improvements occurred in validated psychometric measures for mental health (12-Item General Health Questionnaire, Patient Health Questionnaire-9) and social participation (Participation Scale). Improvements occurred regardless of caregiver status. This intervention addressed mental health and social participation for marginalised groups that are typically without access to formal mental health care and findings suggest Nae Umeed improved mental health and social participation; however, a controlled community trial would be required to prove causation. Community-based group interventions are a promising approach to improving the mental health of vulnerable groups in South Asia.
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Affiliation(s)
- Christopher R. Bailie
- Nossal Institute for Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Pooja S. Pillai
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
| | - Atul Goodwin Singh
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
| | - Jed Leishman
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Nathan J. Grills
- Nossal Institute for Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Kaaren Mathias
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
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Lee LHN, Procyshyn RM, White RF, Gicas KM, Honer WG, Barr AM. Developing prediction models for symptom severity around the time of discharge from a tertiary-care program for treatment-resistant psychosis. Front Psychiatry 2023; 14:1181740. [PMID: 37350999 PMCID: PMC10282838 DOI: 10.3389/fpsyt.2023.1181740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
Antipsychotics are the only therapeutic class indicated in the symptomatic management of psychotic disorders. However, individuals diagnosed with schizophrenia or schizoaffective disorder may not always benefit from these first-line agents. This refractoriness to conventional treatment can be difficult to address in most clinical settings. Therefore, a referral to a tertiary-care program that is better able to deliver specialized care in excess of the needs of most individuals may be necessary. The average outcome following a period of treatment at these programs tends to be one of improvement. Nonetheless, accurate prognostication of individual-level responses may be useful in identifying those who are unlikely to improve despite receiving specialized care. Thus, the main objective of this study was to predict symptom severity around the time of discharge from the Refractory Psychosis Program in British Columbia, Canada using only clinicodemographic information and prescription drug data available at the time of admission. To this end, a different boosted beta regression model was trained to predict the total score on each of the five factors of the Positive and Negative Syndrome Scale (PANSS) using a data set composed of 320 hospital admissions. Internal validation of these prediction models was then accomplished by nested cross-validation. Insofar as it is possible to make comparisons of model performance across different outcomes, the correlation between predictions and observations tended to be higher for the negative and disorganized factors than the positive, excited, and depressed factors on internal validation. Past scores had the greatest effect on the prediction of future scores across all 5 factors. The results of this study serve as a proof of concept for the prediction of symptom severity using this specific approach.
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Affiliation(s)
- Lik Hang N. Lee
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ric M. Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Randall F. White
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Alasdair M. Barr
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
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Kuek JHL, Raeburn T, Liang AG, Wand T. Mental health professionals' perspectives regarding how recovery is conceptualized in Singapore: a constructivist grounded theory study. J Ment Health 2023. [PMID: 36866589 DOI: 10.1080/09638237.2023.2182431] [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: 03/04/2023]
Abstract
BACKGROUND Mental health recovery has shifted from clinical conceptualizations to more personal ones. However, much of the lived experience literature has focused on people living with mental health conditions, and less attention has been placed on various mental health professionals, especially in Asian countries, where the personal recovery literature base is in its nascent stage. AIM We sought to contribute to a growing body of work by exploring recovery from the lens of different mental health professionals in Singapore. METHODS Mental health professionals in Singapore were invited to participate in an online interview through social media. The recordings were transcribed verbatim and analyzed using a constructive grounded theory approach. RESULTS Nineteen participants were interviewed. A single core category, "living in society once more", and three categories, "An ongoing process", "Regaining ability to function in society", and "A normality report card" were identified from our data. CONCLUSIONS Recovery within the Singapore mental health professional perspective focuses on helping individuals return to society and function productively while considering existing societal norms such as the highly competitive and pragmatic culture in Singapore. Future research can explore in greater depth the impact of these factors on the recovery process.
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Affiliation(s)
- Jonathan Han Loong Kuek
- Susan Wakil School of Nursing and Midwifery
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Toby Raeburn
- Faculty of Nursing and Midwifery, Health Sciences & Physiotherapy, The University of Notre Dame, Australia
| | | | - Timothy Wand
- Susan Wakil School of Nursing and Midwifery
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Australia
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Application Research of Humanistic Care and Situational Integration in Nursing of Schizophrenia in Recovery Period. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:4705107. [PMID: 36262979 PMCID: PMC9553477 DOI: 10.1155/2022/4705107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/17/2022] [Accepted: 08/30/2022] [Indexed: 01/26/2023]
Abstract
Objective To formulate corresponding nursing humanistic care measures according to the needs of patients, evaluate the intervention effect of patients, and provide reference for nursing staff to better provide nursing humanistic care for patients with schizophrenia in convalescence. Methods Using the random number table method, 110 inpatients with convalescent schizophrenia were randomly divided into the control group (n = 55) and the experimental group (n = 55). The sample t-test was used to compare the changes of patient insight, treatment attitude, rehabilitation efficacy, and negative emotion score before and after nursing humanistic nursing intervention, and analyze the effect of nursing humanistic care intervention. Results Nursing satisfaction: the nursing satisfaction of the experimental group increased from 84.6% to 96.2%, after intervention, satisfaction of the experimental group was 96.2% higher than that of 86.5% of the control group. Conclusion Nursing intervention measures based on needs of nursing humanistic care can improve nursing satisfaction, insight and treatment attitude of patients, enhance recovery effect of patients, reduce negative emotions of patients, and benefit recovery of patients' conditions.
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