Assessing Mental Health Outcomes in Quarantine Centres: A Cross-Sectional Study during COVID-19 in Malaysia

During the COVID-19 pandemic, persons under surveillance (PUS) were isolated in quarantine centres instead of at home. However, there is limited knowledge regarding the mental health issues experienced by these persons. This study aimed to assess mental health outcomes and associated factors among PUS and frontline workers at quarantine centres. This study conducted an analysis of secondary data from a cross-sectional survey carried out by the Mental Health and Psychosocial Support Services (MHPSS). The MHPSS employed the Depression, Anxiety, and Stress Scale (DASS-21) to evaluate mental health outcomes across 49 quarantine centres in Malaysia. The study included a total of 4577 respondents. The prevalence of stress, anxiety, and depression was found to be 0.9%, 11.4%, and 10.2%, respectively. Frontline workers and being part of the younger age group were found to be associated with depression, anxiety, and stress. Other factors associated with mental health issues were being female, staying at an institution-type centre, and a longer duration of the stay or work at the centre. In conclusion, assessing the mental health status and its associated factors among quarantine centre occupants is crucial for developing future strategies to safeguard their mental well-being.

Challenging and understanding gendered narratives: the development and validation of the transnormativity measure (TM)

Background: Transnormativity refers to the accountability structure that regulates the acceptable gender presentations, narratives, and ways of being of trans and nonbinary (TNB) individuals.Aims: The present research extends prior qualitative research on transnormativity to develop and validate the Transnormativity Measure (TM). Methods: The initial developed pool of potential items was presented to a focus groups and three content experts for review. In Study 1 (N = 497), the 69 initial items of the TM hypothesized to underly a six-factor structure were analyzed using Exploratory Factor Analysis (EFA) and construct and discriminant validity were assessed. In Study 2 (N = 540), an independent sample of TNB participants' TM responses were subjected to Confirmatory Factor Analysis (CFA), invariance testing, and construct and predictive validity. Finally, in Study 3 (N = 107), an Interclass Correlation Coefficients 2-way mixed-effects model of the TM was assessed.Results: EFAs conducted in Study 1 revealed a two-factor structure as the best fit with 50 items removed. Conceptually there was considerable overlap in the items comprising the two factors and it was decided that one general factor should be utilized. Study 1 also provided preliminary construct and discriminant validity due to expected relations between the TM and existing measures of heteronormativity and internalized transphobia. In Study 2 findings from correlational tests of the remaining items revealed that four items were highly correlated and were removed. Subsequent CFA indicated that the one factor model fit the data well. Configural invariance was supported however metric noninvariance was found. Additionally, Study 2 results supported construct and predictive validity through correlations between the TM and measures of TNB community belonginess and mental health outcomes. Finally, Study 3 provided support for test-retest reliability. Discussion: Across three studies, the TM was found to be a valid measure of transnormativity.

Understanding Problematic Gaming During the Covid-19 Pandemic in Adolescents and Adults: A Systematic Review of the Literature

Objective

A growing body of evidence suggests that online gaming increased during the COVID-19 outbreak. This systematic review aims to summarize extant literature that reported on problematic gaming among both adolescents and adults during the pandemic and to identify available research on the bidirectional association between problematic gaming and mental health outcomes.

Method

A systematic search was carried out through PubMed, Web of Knowledge and AGRIS, Embase, Medline, PsychINFO (from January 2020 to January 2023), using keywords related to problematic gaming and mental health outcomes. Both cross-sectional and longitudinal empirical studies which used validated measures of problematic gaming and mental health outcomes during the COVID-19 pandemic were included.

Results

Twenty-five empirical articles were eligible for the current review, comprising 28,978 participants. The majority of the selected studies had cross-sectional designs. Overall, most eligible studies showed significant association between problematic gaming and negative mental health outcomes during the pandemic. Correlations were mostly found between problematic gaming, depression and anxiety.

Conclusions

Future research focusing on the relationship between problematic gaming and mental health outcomes should go beyond the considerable weaknesses due to methodological limitations of cross-sectional design, sampling and measures.

Gender-Based Violence, Subjective Quality of Life, and Mental Health Outcomes Among Palestinian Women: The Mediating Role of Social Support and Agency

We tested the association between gender-based violence (GBV), subjective quality of life, and mental distress manifested by anxiety, depression, and stress among Palestinian women exposed to political and military violence. Depression, Anxiety and Stress Scale-21, Berlin Social Support Scales, WHO-5 subjective Quality of Life Scale, Women's Agency Scale 61, and Violence Against Women Questionnaire were administered to 332 purposely selected participants. Structural equation modeling was applied to address the study hypothesis. A conceptual model depicting GBV as a predictor, mental distress as an outcome variable, and agency and social support as mediators was confirmed.

Hope and mental health problems among orphans and vulnerable children in South Africa

ABSTRACTThere are over three million orphaned and vulnerable children (OVC) currently living in South Africa. OVC are at high risk for a number of negative outcomes, including poor mental health. Hope has been associated with well-being among youth, including youth in South Africa. However, the relationships between hope and mental health in high-adversity populations such as OVC has not been adequately described. The present study sought to address this research gap by evaluating the relationship between hope and mental health, controlling for gender, age, and orphan status, among OVC. This study includes 8- to 12-year-old OVC (N = 61) in Manguang, Free State, South Africa. Hope was assessed using the Children's Hope Scale (CHS) and mental health outcomes were assessed using the Strengths and Difficulties Questionnaire (SDQ). Hope was significantly, inversely associated with mental health outcomes after controlling for other variables in linear regression analysis. In contrast to previous research, this study found that increased hope scores were associated with adverse mental health outcomes among OVC in South Africa. Hope may be contextualized differently in this population due to resource scarcity and high rates of adversity including HIV-AIDS related stigma and poverty.

U.S. vs. Foreign Nativity and 10-Year Trajectories of Mental Health after Traumatic Brain Injury: A Model Systems Study

BACKGROUND

Previous research has found racial and ethnic disparities in life satisfaction, depression, and anxiety after traumatic brain injury (TBI). However, limited studies have examined differences in these variables between U.S.- and foreign-born individuals with TBI. The purpose of this study was to examine whether differences exist in mental health outcomes between U.S.- and foreign-born individuals with TBI at 1, 2, 5, and 10 years after injury, as well as examine whether demographic and injury-related characteristics account for these differences.

METHOD

Participants were 8289 individuals with TBI who identified as U.S.-born and 944 who identified as born outside the U.S. in the TBI Model Systems study. Participants completed measures of mental health outcomes at 1, 2, 5, and 10 years after injury.

RESULTS

Foreign-born individuals with TBI had comparable levels of depression and anxiety trajectories to U.S.-born individuals, yet higher life satisfaction trajectories, even after controlling for demographic and injury-related variables.

CONCLUSION

Rehabilitation professionals should consider in their clinical work the mechanisms that likely influence mental health outcomes among foreign-born individuals, including family-based values that increase resilience, as well as the possible under-reporting of mental health symptoms along the lines of cultural norms.

Mental health outcomes and associated factors among vaccinated and unvaccinated teachers against COVID-19 infection in Bangladesh

Background

Vaccination of teachers is recommended during the COVID-19 pandemic to reduce the risk of infection for themselves and their students, as well as to encourage their parents to get immunized. The present study investigated the mental health outcomes and associated factors among vaccinated and unvaccinated teachers against COVID-19 infection in Bangladesh.

Methods

A cross-sectional survey was conducted in Bangladesh from March 4 to September 9, 2021. The frequency of symptoms of psychological distress, depression, anxiety, stress, post-traumatic stress disorder (PTSD), insomnia, and fear was assessed using the Bangla versions of the GHQ-12, PHQ-2, GAD-2, PSS-4, PC-PTSD-5, ISI, and FCV-19S scales, respectively.

Results

A total of 1,527 Bangladeshi teachers completed the questionnaire, with 678 (44.4%) being vaccinated and 849 (55.6%) being unvaccinated. Compared with unvaccinated teachers, vaccinated teachers had a statistically significant lower prevalence of psychological distress (35.8 vs. 42.9%), depression (37.6 vs. 46.4%), anxiety (31.9 vs. 45.1%), stress (18.3 vs. 32.0%), PTSD (33.0 vs. 43.8%), insomnia (25.2 vs. 36.9%), and fear symptoms (23.3 vs. 29.6%). Among vaccinated teachers, participants with master's or lower degree levels had significantly higher symptoms of depression, stress, and fear than other education levels. Respondents with children had a significantly higher risk of depression, anxiety, stress, and fear symptoms than those who did not have children. Participants who lost family members, friends, or colleagues due to the COVID-19 pandemic had a significantly higher chance of experiencing symptoms of anxiety, PTSD, and fear than those who did not. On the other hand, unvaccinated male teachers were significantly associated with a higher risk of all mental health outcomes except psychological distress and PTSD symptoms compared to female teachers. Participants who were smokers had a significantly higher chance of anxiety, stress, and fear symptoms than non-smokers. Compared to participants with strong social support, those with poor social support had a higher risk of all mental health outcomes except PTSD symptoms.

Conclusion

This study suggests emphasizing the vaccinated to unvaccinated teachers as soon as possible to control the infection and improve mental health outcomes. Vulnerable teachers also required special attention, health-related education, and psychological support.

Voicing the perspectives of stroke survivors with aphasia: A rapid evidence review of post-stroke mental health, screening practices and lived experiences

A rapid evidence review (RER) of empirical literature was conducted to explore aphasic stroke survivors' mental health outcomes and lived experiences, as well as the screening instruments for this cohort. The RER was informed by a critical disability theory approach and synthesised qualitative and quantitative evidence within and across 29 studies, published between 2000 and 2021, from a systematic search of three databases. Understanding the relationship between post-stroke aphasia and mental health outcomes is essential for developing comprehensive treatment strategies and designing appropriate long-term care. Available screening instruments currently only detect depression and anxiety, which are then used to detect further mental health issues. The RER revealed that the current screening instruments demonstrate reliability; however, research remains limited regarding their validity. Furthermore, limited studies include aphasic patients as participants and decision-makers in stroke research. Methodological limitations across studies include comparators and small sample sizes. Importantly, across the studies, there is a lack of representation of culturally diverse and minority participants. Overall, the RER results found a high prevalence of aphasic stroke survivors experiencing depression and other mental health outcomes, indicating that implementing mood screening in a timely manner is essential. In addition, the results support that psychological care pathways must be developed and evaluated in consultation with aphasic patients' and carers' lived experiences to identify stepped levels of care and establish appropriate screening instruments. Furthermore, the health system requires consistency, which would ideally be achieved by establishing staff roles and responsibilities regarding mood screening and supportive care in these psychological care pathways. Including mental health specialists such as social workers and establishing specialist training in the multidisciplinary team would support this endeavour. There is a need for further research regarding mood screening instruments, a diversity of aphasic stroke survivors' lived experiences and the clinical expertise of those providing psychological support.

Challenges and Approaches to Green Social Prescribing During and in the Aftermath of COVID-19: A Qualitative Study

The last decade has seen a surge of interest and investment in green social prescribing, however, both healthcare and social enterprise has been impacted by the COVID-19 crisis, along with restricted access to public green spaces. This study examines the challenges and opportunities of delivering green social prescribing during and in the aftermath of COVID-19, in the light of goals of green social prescribing to improve mental health outcomes and reduce health inequalities. Thirty-five one-to-one interviews were conducted between March 2020 and January 2022. Interviewees included Link Workers and other social prescribers, general practitioners (GPs), managers, researchers, and volunteers working in urban and rural Scotland and North East England. Interview transcripts were analyzed in stages, with an inductive approach to coding supported by NVivo. Findings revealed a complex social prescribing landscape, with schemes funded, structured, and delivered diversely. Stakeholders were in general agreement about the benefits of nature-based interventions, and GPs and volunteers pointed out numerous benefits to participating in schemes such as parkrun. Link Workers were more circumspect about suggesting outdoor activities, pointing out both psychological and practical obstacles, including health anxieties, mobility issues, and transport deficits. Exacerbated by the pandemic, there was a way to go before older and/multi-morbidity clients (their largest cohort) would feel comfortable and safe to socialize in open air spaces. Our findings support the premise that time spent in open green spaces can alleviate some of the negative mental health effects compounded by the pandemic. However, the creation of healthy environments is complex with population health intrinsically related to socioeconomic conditions. Social disadvantage, chronic ill health and health crises all limit easy access to green and blue spaces, while those in the most socially economically deprived areas receive the lowest quality of healthcare. Such health inequities need to be borne in mind in the planning of schemes and claims around the potential of future nature-based interventions to reduce health inequalities.

Moral Injury as a Mediator of the Associations Between Sexual Harassment and Mental Health Symptoms and Substance Use Among Women Veterans

Moral injury is an array of symptoms theorized to develop in response to morally injurious events, defined as events that challenge one's core moral beliefs and expectations about the self, others, and world. Recent measures of moral injury have distinguished self-directed moral injury (e.g., moral injury symptoms that emerge following the perpetration of morally injurious events) from other-directed moral injury, the symptoms of which are believed to stem from one's response to actions that others have committed (e.g., within-rank violence, failures of leadership, and acts of betrayal committed by trusted others or institutions). Using a convenience sample of 154 primarily former military women, the present study examined if other-directed moral injury symptoms (e.g., anger, betrayal, and mistrust) associated with military experience would mediate the association between military sexual harassment and mental health and substance abuse symptoms. Results demonstrated that 85.8% (n = 127) of the of this sample of women veterans reported experiencing sexual harassment during their military service. Using a single mediation model, we further demonstrated that other-directed moral injury mediated the association between sexual harassment experience and mental health symptoms. Given the percentage of women veterans who reported sexual harassment, these results suggest that additional training for military members, and particularly, military leaders, is necessary to begin to reduce sexual harassment. In addition, mental health providers who work with current and former military members should consider how other-directed moral injury may be associated with mental health symptoms among women veterans who have experienced sexual harassment while in the military.

The Relationship between Exercise and Mental Health Outcomes during the COVID-19 Pandemic: From the Perspective of Hope

The unexpected outbreak of COVID-19 triggered fear and anxiety in the general population. Exercise was one of the most widely promoted methods to improve body function when socially restricted. This study aims to examine the role of exercise in relieving stressful mental health outcomes (anxiety and depressive symptoms) during the COVID-19 pandemic and explore the underlying mechanism from the perspective of hope, using a combination of goal-directed planning (pathways) and motivation (agency). A cross-sectional online survey recruiting 2390 Chinese participants was conducted during the COVID-19 pandemic in China. A series of questions and scales, including the self-designed exercise questionnaire, the Adult Dispositional Hope Scale, the Generalized Anxiety Disorder Scale-7 and the Patient Health Questionnaire-9, were used to measure exercise, hope, anxiety symptoms and depressive symptoms, respectively. A structural equation model was constructed to test the hypothesis that exercise benefits mental health outcomes through the mediating role of hope. Our results showed that exercise relieved stressful mental health outcomes via three paths: one direct path (β = −0.077, 95% CI = (−0.138, −0.017), p < 0.01), one indirect path through hope of pathways thinking (β = −0.046, 95% CI = (−0.064, −0.027), p < 0.001) and another indirect path through hope of agency thinking (β = −0.060, 95% CI = (−0.081, −0.039), p < 0.001). Our results showed that exercise could alleviate stressful mental health outcomes by promoting both hope of pathway thinking and agency thinking. It provided practical insights into psychological prevention and intervention by means of exercise during the COVID-19 pandemic.

Cost-Benefit Analysis of an Intervention in Divorced Parents: Implications for Society, Public Administrations and Family Visitation Centers

Families going through conflictive divorce processes are at increased risk of developing mental health problems. The Egokitzen program is a group intervention for parents who have undergone a divorce process, funded by the public administration. Budgetary constraints cause funding institutions to be interested in the effectiveness and economic efficiency of these programs. Therefore, the objective of this research is to carry out an efficiency analysis of the Egokitzen program, implemented by family visitation centers in Spain, through a cost-benefit analysis, to determine whether the positive impact on symptomatology (measured using CBCL and SCL-90 instruments) is translated into a positive economic impact for society. A sample of 382 parents participated. Costs will be first identified and valued; secondly, benefits achieved with the program will be identified through a prevalence analysis and, finally, the cost-benefit comparative analysis will be carried out. Additionally, a sensitivity analysis will be performed. The results obtained in the analysis indicate that for every euro spent on this program, the public administration and society save 3.10 euros in future interventions through medical costs and productivity losses. The study has practical implications for public administration, organizations, and the family visitation centers that implement the program.

Animal-Assisted Interventions for the Improvement of Mental Health Outcomes in Higher Education Students: A Systematic Review of Randomised Controlled Trials

BACKGROUND

The aim of this systematic review was to evaluate the effectiveness of Animal-Assisted Interventions (AAIs), particularly Animal-Assisted Therapy (AAT) and Animal-Assisted Activity (AAA), in improving mental health outcomes for students in higher education. The number of students in higher education reporting mental health problems and seeking support from universities' student support services has risen over recent years. Therefore, providing engaging interventions, such as AAIs, that are accessible to large groups of students are attractive.

METHODS

MEDLINE, PsycINFO, Embase and Cochrane Library were searched from relative inception to end of April 2020. Additionally, a grey literature search was undertaken. Independent screening, data extraction and risk of bias assessment were completed, with varying percentages, by two reviewers.

RESULTS

After de-duplication, 6248 articles were identified of which 11 studies were included in the narrative synthesis. The evidence from randomised controlled trials suggests that AAIs could provide short-term beneficial results for anxiety in students attending higher education but with limited evidence for stress, and inconclusive evidence for depression, well-being and mood. For the non-statistically significant results, the studies either did not include a power calculation or were under-powered.

CONCLUSIONS

Potential emerging evidence for the short-term benefits of AAI for anxiety, and possibly stress, for students in higher education was found.

The young adult service: An evaluation of a youth mental health service in the independent sector in Ireland

AIMS

Increasing concerns about the specific needs and rates of mental illness among young adults have spurred the development of youth mental health services. Yet few outcome studies exist. This study aims to evaluate a young adult service in an independent mental health sector in Ireland.

METHODS

This is a service evaluation using a retrospective, descriptive and naturalistic study design. Routine demographic, diagnostic and service usage data were collected at entry into the service. Outcomes were recorded at discharge from the service using the Clinical Global Impression (CGI) improvement scores. Factors associated with better or worse outcomes were analyzed.

RESULTS

Five hundred and sixty-seven young adults were assessed and managed during a 3-year period by the Young Adult Service. Their characteristics fell midway between adolescent and adult mental health service populations. They had high levels of Axis I & II co-morbidities reflecting the complex and fluid nature of emerging conditions in this age group. The majority (62.8%) had clinically improved by the end of follow-up. Outcomes were significantly better in those who were hospitalized, prescribed psychotropic medication, received 1:1 psychology sessions and attended a group-based psychology program or group program for specific disorders. One hundred and sixty-six patients (29.3%) dropped out of follow-up. Drop out was associated with longer time spent in the service, being treated solely in the community, without medication, not having a developmental disorder and not transferring from CAMHS.

CONCLUSIONS

This study demonstrates that it is possible to establish an effective youth mental health service with favourable outcomes within a broader mental health system. It provides a benchmark for similar services, bridging the gap between adolescent and adult mental health services.

Mental Health and Health-Related Quality of Life Among Nephrology Nurses: A Survey-Based Cross-Sectional Study

Nephrology nurses face health and wellness challenges due to significant work-related stressors. This survey, conducted online between July 24 and August 17, 2020, assessed the psychological well-being of nephrology nurses in the United States during the COVID-19 pandemic (n = 393). Respondents reported feeling burned out from work (62%), symptoms of anxiety (47% with Generalized Anxiety Disorder-7 [GAD-7] scores ≥ 5), and major depressive episodes (16% with Patient Health Questionnaire-2 [PHQ-2] scores ≥ 3). Fifty-six percent (56%) of survey respondents reported caring for COVID-19 patients, and 62% were somewhat or very worried about COVID-19. Factors, including high workload, age, race, and the COVID-19 pandemic, may partially explain the high proportion of nephrology nurses who reported symptoms of burnout, anxiety, and depression.

Childhood adversities and mental health outcomes: Does the perception or age of the event matter?

The current study extends knowledge regarding the individual contribution of different adverse experiences to mental health symptoms in late adolescence by including the perception of how upsetting each experience was to the adolescent and the age at the first occurrence. We also sought to move beyond sum scores of adverse experiences by using a person-centered approach to classifying individuals with similar co-occurrence of adversities. The data came from a longitudinal study of maltreatment on adolescent development (N = 454). Self-reported childhood adversities were assessed at Wave 4 (average of 7 years postbaseline) and examined with respect to current mental health symptoms (depression, PTSD, anxiety, and externalizing). Although the adversity sum score was a potent predictor of all mental health outcomes, the results indicated that the use of a sum score obscures information about the importance of individual adversities. Additionally, the influence of age of occurrence varied based on the adversity and outcome, while the perception of the event did not add much unique variance. Finally, the latent class analyses provided unique information about the patterns of co-occurring adversity in this sample, and that membership in either of the multiple-adversity classes was associated with more mental health symptoms.

Predictors of Mental Health Outcomes in Grocery Store Workers amid the COVID-19 Pandemic and Implications for Workplace Safety and Moral Injury

Limited research exists on the mental health (MH) of grocery store workers (GSWs), who have been on the frontlines throughout the COVID-19 pandemic. A disaster MH conceptual model incorporating demographics, disaster exposure and threat (COVID-19 fear and workplace threat perception), perceived stress, and social support (lack of from family and friends) was utilized to predict MH outcomes (anxiety, depression, and post-traumatic stress symptoms; PTSS) of GSWs. GSWs (n = 842) were recruited through a regional union in California. The participants were diverse (62.1% female) and were 18-69 years of age (M = 41.5, SD = 13.9). They completed an online survey regarding COVID-19 fear, workplace threat perception, perceived stress, lack of social support, and workplace needs/recommendations for support. Three hierarchical linear regression models were run assessing each MH outcome. Thematic analysis coding and an inductive approach were utilized for analyzing open-ended responses of workplace needs/recommendations. Females and younger GSWs (ages 18-29 years old) on average, reported higher MH symptoms than males and older age groups, respectively. COVID-19 fear and perceived stress were significant predictors of anxiety, while COVID-19 fear, workplace threat perception, and perceived stress significantly predicted depression and PTSS, explaining almost half of the variance for each model. Social support and demographics were not predictive of MH outcomes. Almost half of GSWs (40%) requested increased safety protections in the workplace. Feelings of fear of COVID-19, threat in the workplace, and overall perceived stress are predictive of GSWs' MH outcomes. Increasing feelings of safety in the workplace and reducing stress may lessen MH symptoms.

Early adult mental health, functional and neuropsychological outcomes of young people who have reported psychotic experiences: a 10-year longitudinal study

BACKGROUND

Psychotic experiences (PE) are highly prevalent in childhood and are known to be associated with co-morbid mental health disorders and functional difficulties in adolescence. However, little is known about the long-term outcomes of young people who report PE.

METHODS

As part of the Adolescent Brain Development Study, 211 young people were recruited in childhood (mean age 11.7 years) and underwent detailed clinical interviews, with 25% reporting PE. A 10 year follow-up study was completed and 103 participants returned (mean age 20.9 years). Structured clinical interviews for DSM-5 (SCID-5) and interviewer-rated assessments of functioning were conducted. A detailed neuropsychological battery was also administered. Analyses investigated group differences between those who had ever reported PE and controls in early adulthood.

RESULTS

The PE group was at a significantly higher risk of meeting DSM-5 criteria for a current (OR 4.08, CI 1.16-14.29, p = 0.03) and lifetime psychiatric disorder (OR 3.27, CI 1.43-7.47, p = 0.005). They were also at a significantly higher risk of multi-morbid lifetime psychiatric disorders. Significantly lower scores on current social and global functioning measures were observed for the PE group. Overall, there were no differences in neuropsychological performance between groups apart from significantly lower scores on the Stroop Word task and the Purdue Pegboard task for the PE group.

CONCLUSIONS

Our findings suggest that reports of PE are associated with poorer mental health and functional outcomes in early adulthood, with some persisting cognitive and motor deficits. Young people who report such symptoms could be considered a target group for interventions to aid functional outcomes.

Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project

LAY ABSTRACT

Autistic adults commonly experience mental health conditions. However, research rarely involves autistic adults in deciding priorities for research on mental healthcare approaches that might work for them. The purpose of this article is to describe a stakeholder-driven project that involved autistic adults in co-leading and designing research about priorities to address mental health needs. Through a large online survey, two large meetings, and three face-to-face focus group discussions involving over 350 stakeholders, we identified five priorities for mental health research desired by autistic adults. These priorities and preferred outcomes should be used to guide research and practice for autistic adults.

Classifying childhood war trauma exposure: latent profile analyses of Sierra Leone's former child soldiers

BACKGROUND

Former child soldiers are at elevated risk for mental health problems (e.g., traumatic stress, emotion dysregulation, and internalizing and externalizing problems). To examine which groups of former child soldiers are more likely to have difficulties with emotion regulation, interpersonal relationships, and mental health postconflict, we explored patterns of war trauma exposure and their effects on subsequent mental health problems among former child soldiers in Sierra Leone.

METHODS

Participants were 415 (23.86% female) Sierra Leonean former child soldiers participating in a 15-year, four-wave longitudinal study. At T1 (2002), 282 former child soldiers (aged 10-17) were recruited. T2 (2004) included 186 participants from T1 and an additional cohort of self-reintegrated former child soldiers (NT2 = 132). T3 (2008) and T4 (2016/2017) participants were youth enrolled in previous waves (NT3 = 315; NT4 = 364). Latent profile analysis (LPA) was used to classify participants based on the first-time reports of eight forms of war exposure (separation and loss of assets, parental loss, loss of loved ones, witnessing violence, victimization, perpetrating violence, noncombat activities, and deprivation). ANOVA examined whether patterns of war exposure were associated with sociodemographic characteristics and mental health outcomes between T1 and T4.

RESULTS

LPA identified two profiles: higher exposure versus lower exposure, using cumulative scores of eight forms of war-related trauma exposure. The 'higher war exposure' group comprised 226 (54.5%) former child soldiers and the 'lower war exposure' group included 189 (45.5%). Significantly higher levels of violence-related and combat experiences characterized the group exposed to more traumatic events. The 'higher war exposure' group reported more PTSD symptoms at T2, more hyperarousal symptoms across all waves, and more difficulties in emotion regulation at T4.

CONCLUSIONS

Former child soldiers exposed to higher levels of war-related traumatic events and loss should be prioritized for mental health services immediately postconflict and as they transition into adulthood.

Rapid Evidence Assessment of Mental Health Outcomes of Pandemics for Health Care Workers: Implications for the Covid-19 Pandemic

Background: Little is known about the long-term mental health (MH) impact of the Covid-19 pandemic on health care workers (HCWs). However, synthesizing knowledge from past pandemics can help to anticipate this, along with identifying interventions required, when, and target populations most in need. This paper provides a balanced evaluation of what is currently known about short- and long-term MH impacts of pandemics on HCWs and effect of methodological limitations on knowledge claims. Method: A rapid evidence assessment (REA) was conducted on 41 studies published in the past two decades that examined MH outcomes for HCWs in relation to pandemics. Results: Findings of literary synthesis highlight common MH outcomes across pandemics, including increased stress, distress, burnout, and anxiety in the short-term, and post-traumatic stress and depression in the long-term. Findings also show the key role that organizations and public health bodies play in promoting adaptive coping and reducing health worries and the emotional and psychological distress caused by this. Evidence highlights particular groups at risk of developing MH issues (contact with patients that are infected, having children), and time points where risk may increase (initial response phase, when quarantined). However, inconsistencies in measures, analysis, and reporting all create limitations for pooling data. Conclusions: Findings can be used by researchers to provide a knowledge framework to inform future research that will assist HCWs in responding to pandemics, and by policy makers and service planners to provide an evidence-led brief about direction and evidence base for related policy initiatives, interventions or service programmes.

Unravelling the mental health productivity puzzle: where do we start?

In this editorial we define 'productivity' and 'efficiency' in a mental health service context, outlining the key challenges to measuring these in practice. We attempt to bring clarity of thought to this often debated, but rarely researched area.

Understanding different trajectories of mental health across the general population during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic and nationally mandated restrictions to control the virus have been associated with increased mental health issues. However, the differential impact of the pandemic and lockdown on groups of individuals, and the personal characteristics associated with poorer outcomes are unknown.

METHOD

Data from 21 938 adults in England who participated in a stratified cohort study were analysed. Trajectories of depression and anxiety symptoms were identified using growth mixture modelling. Multinomial and logistic regression models were constructed to identify sociodemographic and personality-related risk factors associated with trajectory class membership.

RESULTS

Four trajectories of depression and five for anxiety were identified. The most common group presented with low symptom severity throughout, other classes were identified that showed: severe levels of symptoms which increased; moderate symptoms throughout; worsening mental health during lockdown but improvements after lockdown ended; and for anxiety only, severe initial anxiety that decreased quickly during lockdown. Age, gender, ethnicity, income, previous diagnoses, living situation, personality factors and sociability were associated with different trajectories.

CONCLUSIONS

Nearly 30% of participants experienced trajectories with symptoms in the clinical range during lockdown, and did not follow the average curve or majority group, highlighting the importance of differential trajectories. Young, female, outgoing and sociable people and essential workers experienced severe anxiety around the announcement of lockdown which rapidly decreased. Younger individuals with lower incomes and previous mental health diagnoses experienced higher and increasing levels of symptoms. Recognising the likely symptom trajectories for such groups may allow for targeted care or interventions.

Symptoms of anxiety, depression, and borderline personality in alcohol use disorder with and without comorbid substance use disorder

OBJECTIVE

Alcohol use disorder (AUD) is highly comorbid with other substance use disorders (SUDs) as well as other psychiatric disorders, such as anxiety, depression, and Borderline Personality Disorder (BPD). However, studies of persons with AUD rarely account for its comorbidity with other SUDs. Some research suggests that BPD symptoms reflect an important connection between internalizing disorders and SUDs. The current study investigated: 1) the levels of trait anxiety and symptoms of depression and BPD in persons with an AUD as a function of comorbid SUDs (cannabis use disorder - CUD) and other substance use disorder (oSUD), and 2) the influence of BPD on the association between severity of overall lifetime SUD symptoms (AUD + CUD + oSUD) and both trait anxiety and symptoms of depression.

METHOD

Trait anxiety and symptoms of depression and BPD were assessed in 671 young adults (351 men; 320 women; mean age 21 years) separated into four groups: Controls (n = 185), AUD-only (134), AUD + CUD (n = 210), and AUD + oSUD (n = 142).

RESULTS

Trait anxiety and symptoms of depression and BPD were elevated in all AUD groups compared with controls, and in the AUD + oSUD group compared with all other groups as well. Structural models also indicated that BPD symptoms accounted for all of the variance in lifetime SUD symptoms associated with Trait Anxiety, and a significant portion of the variance in lifetime SUD symptoms associated with depression symptoms.

CONCLUSION

Results indicate that when AUD is comorbid with oSUD, it is associated with more severe AUD symptoms and higher levels of trait anxiety and symptoms of both depression and BPD. The results also indicate that BPD symptoms account for the majority of the variance in SUD symptoms associated with both trait anxiety and depression, suggesting that a considerable amount of the internalizing symptomatology in AUD/SUDs is associated with BPD psychopathology.

COVID-19 and Obstetrical Care: Coping With New Stress

Objective Our study aimed to assess the mental health outcomes and coping strategies among healthcare workers (HCWs) in an already over-burdened maternity ward and labour room during the coronavirus disease 2019 (COVID-19) pandemic. Methods This cross-sectional questionnaire survey was conducted using Google Forms (Google LLC, Mountain View, CA), which included demographic characteristics, perceived stressors, and validated scales: the Depression, Anxiety and Stress Scale - 21 Items (DASS-21), Insomnia Severity Index, and the Brief Coping Orientation to Problems Experienced (Brief COPE) scale. The results were evaluated and compared among COVID-19 caregivers and other HCWs. Results A total of 184 participants were included in the study, out of which 112 (60.9%) were COVID-19 caregivers. Overall, HCWs managing COVID-19 patients experienced significantly higher levels of depression, anxiety, and stress. They often adopted an avoidant coping style (p-value: 0.006). The results of binary logistic regression analysis revealed that living with family and perceiving multiple stressors appeared to be associated with increased risk of anxiety while being a COVID-19 caregiver and appeared to be a risk factor for stress. Avoidant coping was found to be associated with insomnia while approach coping was less associated with anxiety. The most prevalent stressor among HCWs at our institute was distancing from family and friends (62%) followed by fear of getting infected (51.1%). Compared to other HCWs, the stressors perceived in significantly higher proportion by COVID-19 caregivers included distancing from family and friends (p-value: 0.003), scarcity of workforce (p-value: 0.005), and dealing with non-cooperative patients (p-value: <0.001). Conclusion We would request the immediate attention of the concerned authorities to implement interventions to buffer the impact of COVID-19 in the already stressed-out maternity wards and labour rooms.

Quality of life and functional outcomes with tapentadol prolonged release in chronic musculoskeletal pain: post hoc analysis

Aims: To investigate quality of life (QOL) and functionality changes in chronic pain during tapentadol prolonged release (PR) treatment. Patients & methods: Post hoc analysis of data from three Phase III trials in patients with osteoarthritis knee pain or low back pain. QOL and functionality changes were assessed by SF-36 scores. Results: All SF-36 subdomain scores improved progressively to week 3 of tapentadol titration and were sustained during 12-week maintenance treatment. Improvements in SF-36 scores were similar between tapentadol dose groups (e.g., 200 to <300 mg vs ≥500 mg), with no greater effect from higher doses. QOL and functionality improvements were consistently greater with tapentadol PR than oxycodone controlled release. Conclusion: Tapentadol PR provides consistent, clinically relevant improvements in QOL and functionality in chronic pain.

Sexual orientation and mental health over the life course in a birth cohort

BACKGROUND

Sexual minority individuals consistently report higher rates of mental disorder than heterosexuals. However, much of the research has methodological limitations related to the classification of sexuality, the use of cross-sectional data and problematic sampling procedures such as using convenience samples.

METHODS

We used longitudinal data from a birth cohort enrolled in the Christchurch Health and Development Study (n = 1040). Latent class analysis was used to classify participants sexuality based on self-report data of sexual behaviour, attraction, identity and fantasy, gathered over five assessments between the ages of 18 and 35 years. Mental health and substance use outcome data were gathered at four assessments between the ages of 21 and 35 years. Potential covariate variables were collected during childhood.

RESULTS

The latent class analysis identified four groups interpreted as: 'heterosexual' 82%, 'mostly heterosexual' 12.6%, 'bisexual' 3.5% and 'gay/lesbian' 1.9%. In the sexual minority groups, women outnumbered men by at least 2:1. Pooled rates for mental health disorders of depression, anxiety disorders, suicidal ideation, cannabis abuse and total disorders, after adjustment for childhood covariate variables, were significantly higher in the sexual minority groups (p < 0.01). The strength of association between sexuality group and mental health outcomes did not differ according to sex. Fluidity in sexuality reports appeared unrelated to risk of mental health outcomes.

CONCLUSIONS

Over the life course, membership of a sexual minority group is clearly associated with mental health problems of depression, anxiety and suicidal ideation regardless of the age when same-sex attraction, behaviour, identity or fantasy is expressed.

Study of mental health outcomes associated with different brands of venlafaxine at the Kumeu medical centre from January 2017 to October 2018

BACKGROUND

The antidepressant venlafaxine has been available in New Zealand for two decades and is funded by the New Zealand Drug Purchasing Agency PHARMAC. This audit aimed to determine whether change to a different funded generic formulation of venlafaxine affected patient responses to venlafaxine.

METHODS

A retrospective review of patient records for all patients at Kumeu Medical Centre, Auckland, New Zealand who received a prescription for venlafaxine since January 2017 was performed. Outcomes for patients who had experienced a stable positive clinical response to either of the two previously funded venlafaxine formulations and who were switched to the newly funded formulation were summarised.

RESULTS

Of 49 patients who had been prescribed venlafaxine, 34 patients were excluded; 15 patients had experienced a stable positive clinical response to either of the two previously funded venlafaxine formulations and switched to the newly funded formulation. Of these, 12 (80%) had poor outcomes following the change in venlafaxine formulation. Nine patients switched back to the original brand venlafaxine and showed improvement in clinical symptoms.

CONCLUSION

These cases, reported from a single general practice, should be sufficient to call attention to the possibility of loss of effectiveness for patients treated with a funded generic brand of venlafaxine, and the need for further research.

Recorded poor insight as a predictor of service use outcomes: cohort study of patients with first-episode psychosis in a large mental healthcare database

OBJECTIVES

To investigate recorded poor insight in relation to mental health and service use outcomes in a cohort with first-episode psychosis.

DESIGN

We developed a natural language processing algorithm to ascertain statements of poor or diminished insight and tested this in a cohort of patients with first-episode psychosis.

SETTING

The clinical record text at the South London and Maudsley National Health Service Trust in the UK was used.

PARTICIPANTS

We applied the algorithm to characterise a cohort of 2026 patients with first-episode psychosis attending an early intervention service.

PRIMARY AND SECONDARY OUTCOME MEASURES

Recorded poor insight within 1 month of registration was investigated in relation to (1) incidence of psychiatric hospitalisation, (2) odds of legally enforced hospitalisation, (3) number of days spent as a mental health inpatient and (4) number of different antipsychotic agents prescribed; outcomes were measured over varying follow-up periods from 12 months to 60 months, adjusting for a range of sociodemographic and clinical covariates.

RESULTS

Recorded poor insight, present in 48.9% of the sample, was positively associated with youngest and oldest age groups, unemployment and schizophrenia (compared with bipolar disorder) and was negatively associated with Asian ethnicity, married status, home ownership and recorded cannabis use. It was significantly associated with higher levels of all four outcomes over the succeeding 12 months. Associations with hospitalisation incidence and number of antipsychotics remained independently significant when measured over 60 and 48 months, respectively.

CONCLUSIONS

Recorded poor insight in people with recent onset psychosis predicted higher subsequent inpatient mental healthcare use. Improving insight might benefit patients' course of illness as well as reduce mental health service use.

Effects of Poly-Victimization Before Age 18 on Health Outcomes in Young Kenyan Adults: Violence Against Children Survey

Children's exposure to poly-victimization, which is the experience of multiple types of victimization, has been found to be associated with negative health outcomes and risk behaviors. We examined the collective effects of childhood sexual, physical, and emotional violence on selected self-reported health outcomes among young Kenyan females and males using the Violence Against Children Survey (VACS). Overall, 76.2% of females and 79.8% of males were victims of sexual, physical, or emotional violence prior to age 18, and one-third (32.9% and 34.5%, respectively) experienced two or more types of violence. Poly-victimization was significantly associated with current feelings of anxiety, depression, and suicidal thoughts in females and males, as well as self-reported fair or poor health in males (p < .05) as compared to those who experienced no violence. The study data demonstrate an urgent need to reduce all types of violence against children, as well develop appropriate strategies for its prevention.

Exposure to potentially traumatic events in young Swiss men: associations with socio-demographics and mental health outcomes (alcohol use disorder, major depression and suicide attempts)

Background and objective: The aims of this study were to estimate the lifetime and 12-month prevalence of exposure to potentially traumatic events (PTEs) in young men in Switzerland and to assess factors and mental health outcomes associated with such events. Method: Data were drawn from the Cohort Study on Substance Use Risk Factors (C-SURF), encompassing 5,223 young men. Exposure to PTEs was assessed using the Post-traumatic Diagnostic Scale (PDS), Trauma History Questionnaire (THQ) and Life Event Checklist (LEC). Results: Lifetime prevalence of PTEs was 59.4%, with 37.3% reporting multiple types of events. Twelve-month prevalence was 31.2%, with 12.7% reporting multiple types of events. Low education level of participants, high maternal education, family affluence below average, and not living with biological parents were associated with a higher risk of having experienced one or more PTEs in one's lifetime. Low education level of participants and high maternal education were also related to exposure to one or more PTEs over the past 12 months. Logistic regression analyses demonstrated that PTE exposure was directly associated with all assessed mental health outcomes. The strongest relationship was found between exposure to multiple types of PTEs and suicide attempts (adjusted OR 4.9 [95% CI: 2.9-8.4]). Conclusions: These results indicate that having experienced one or multiple types of PTEs is common in Swiss young men. Efforts should be intensified to reduce exposure to PTEs and prevent and treat resulting problematic mental health outcomes in young adults.

Population Survey Data Informing the Therapeutic Potential of Classic and Novel Phenethylamine, Tryptamine, and Lysergamide Psychedelics

INTRODUCTION

The majority of contemporary psychedelic research has focused on ayahuasca, lysergic acid diethylamide, and psilocybin, though there are hundreds of novel psychedelic compounds that may have clinical utility. The purpose of the present study was to evaluate the therapeutic potential of classic and novel phenethylamine, tryptamine, and lysergamide psychedelics via a large, nationally representative population-based survey.

METHODS

We tested the unique associations of lifetime classic and novel phenethylamine, tryptamine, and lysergamide psychedelics with past month psychological distress and past year suicidality among respondents pooled from years 2008-2017 of the National Survey on Drug Use and Health (weighted N = 260,964,827).

RESULTS

Lifetime classic tryptamine use was associated with a decreased odds of past month psychological distress [aOR = 0.76; (0.69-0.83)] and past year suicidal thinking [aOR = 0.79; (0.72-0.87)]. Lifetime novel phenethylamine use, on the other hand, was associated with an increased odds of past year suicidal thinking [aOR = 1.44; (1.06-1.95)] and past year suicidal planning [aOR = 1.60; (1.06-2.41)]. No other significant associations were found.

DISCUSSION AND CONCLUSIONS

These findings, which may be driven by differences in pharmacodynamics, suggest that classic tryptamines may hold the greatest therapeutic potential of the psychedelics, whereas novel phenethylamines may pose risk for harm. The present findings thus support continued research on the clinical application of classic tryptamines. Though the current results caution against the clinical utility of novel phenethylamines, further study of these and other novel psychedelic substances is nonetheless warranted to better understand their potential application.

Health, Education and Employment Outcomes in Young Refugees in the Nordic Countries: A Systematic Review

Objectives: Since 2000, approximately 500,000 refugees have settled in the Nordic countries, about a third of them being children and young people. To identify general trends, and to detect gaps in the existing knowledge about the socioeconomic and health status of these young refugees, this review discusses the literature regarding three key areas related to welfare policy: health, education and employment. Methods: A systematic search in PubMed, Scopus, SocINDEX, Sociological Abstracts, Embase and Cochrane, and a search for publications from relevant institutions were undertaken. All publications had to be original quantitative studies published since 1980. The total number of studies identified was 1353, 25 publications were included. Results: Young refugees had poorer mental health than ethnic minority and native-born peers. Mental health problems were related to pre-migration experiences but also to post-migration factors, such as discrimination and poor social support. Refugees performed worse in school than native-born and few progressed to higher education. Experiencing less discrimination and having better Nordic language proficiency was associated with higher educational attainment. A higher proportion of refugees were unemployed or outside the labour force compared with other immigrants and native-born. Assessment instruments varied between studies, making comparisons difficult. Conclusions: The study suggests pre-migration factors but also post-migration conditions such as perceived discrimination, social support and Nordic language proficiency as important factors for the mental health, education and employment outcomes of young refugees in the Nordic countries. Further Nordic comparative research and studies focusing on the relationship between health, education and employment outcomes are needed.

Relationship between negative social reactions to sexual assault disclosure and mental health outcomes of Black and White female survivors

OBJECTIVE

This study investigates the effect of race on the relationship between negative reactions to sexual assault disclosure and the psychological sequelae such as posttraumatic stress disorder (PTSD), depression, and problem drinking in female sexual assault survivors.

METHOD

Using hierarchical regression in an ethnically diverse community sample of 622 female adult sexual assault victims, we assessed for sexual assault; negative reactions to sexual assault disclosure; and symptom severity for PTSD, depression, and problem drinking.

RESULTS

Negative social reactions to sexual assault disclosures were significantly associated with negative mental health outcomes across race. Race moderated the influence of negative disclosure reactions on psychological symptoms; however, the moderation was not similar across racial groups and psychological outcome measures. Although Black and White survivors evidenced distress through depression, PTSD, and substance use, Black women who received low to moderate negative reactions to their disclosures of assault were more likely to show increases in PTSD and depression whereas high negative reactions to disclosure were related to higher PTSD and depression similarly for both Black and White women. In addition, Black and White women who experienced more negative social reactions had greater substance abuse, with no difference by race.

CONCLUSION

The results provide further support for detrimental effects of negative reactions on Black and White survivors and highlight the importance of educating people in the community about sexual assault and how to respond in more supportive ways. (PsycINFO Database Record

Perceptions and receptivity of non-spousal family support: A mixed methods study of psychological distress among older, church-going African American men

The purpose of this study was to explore the role of non-spousal family support on mental health among older, church-going African American men. The mixed methods objective was to employ a design that used existing qualitative and quantitative data to explore the interpretive context within which social and cultural experiences occur. Qualitative data (n=21) were used to build a conceptual model that was tested using quantitative data (n= 401). Confirmatory factor analysis indicated an inverse association between non-spousal family support and distress. The comparative fit index, Tucker-Lewis fit index, and root mean square error of approximation indicated good model fit. This study offers unique methodological approaches to using existing, complementary data sources to understand the health of African American men.

Impact of falls on mental health outcomes for older adult mental health patients: An Australian study

Sustaining a fall during hospitalization reduces a patient's ability to return home following discharge. It is well accepted that factors, such as alteration in balance, functional mobility, muscle strength, and fear of falling, are all factors that impact on the quality of life of elderly people following a fall. However, the impact that falls have on mental health outcomes in older adult mental health patients remains unexplored. The present study reports Health of the Nation Outcome Scale scores for people over the age of 65 (HoNOS65+), which were examined in a cohort of 65 patients who sustained a fall and 73 non-fallers admitted to an older adult mental health service (OAMHS). Results were compared with state and national HoNOS65+ data recorded in Australian National Outcome Casemix Collection data to explore the effect that sustaining a fall while hospitalized has on mental health outcomes. Australian state and national HoNOS65+ data indicate that older adults generally experience improved HoNOS65+ scores from admission to discharge. Mental health outcomes for patients who sustained a fall while admitted to an OAMHS did not follow this trend. Sustaining a fall while admitted to an OAMHS negatively affects discharge mental health outcomes.

Twelve-Month Effects of the COPE Healthy Lifestyles TEEN Program on Overweight and Depressive Symptoms in High School Adolescents

BACKGROUND

We evaluated the 12-month effects of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) program versus an attention control program (Healthy Teens) on overweight/obesity and depressive symptoms in high school adolescents.

METHODS

A cluster randomized controlled trial was conducted. Participants were 779 culturally diverse adolescents in the US Southwest. COPE is a cognitive-behavioral skills-building intervention with 20 min of physical activity integrated into a health course and taught by teachers once a week for 15 weeks. Outcome measures included body mass index (BMI) and depressive symptoms.

RESULTS

COPE teens had a significantly lower BMI at 12 months (F(1,698)  = 11.22, p = .001) than Healthy Teens (24.95 versus 25.48). There was a significant decrease in the proportion of overweight and obese COPE teens from baseline to 12 months (χ(2)  = 5.40, p = .02) as compared with Healthy Teens. For youth who began the study with extremely elevated depressive symptoms, COPE teens had significantly lower depression at 12 months compared with Healthy Teens (COPE M = 42.39; Healthy Teens M = 57.90); (F(1 ,12)  = 5.78, p = .03).

CONCLUSIONS

COPE can improve long-term physical and mental health outcomes in teens.

Personality characteristics in childhood and outcomes in adulthood: findings from a 30 year longitudinal study

OBJECTIVE

Personality has been associated with a variety of outcomes in adulthood. Most of the literature related to mental state disorder and personality is cross sectional.

METHODS

Data from more than 900 participants of the Christchurch Health and Development Study (CHDS) were examined. Extroversion and neuroticism were measured at 14 years old and social outcomes at age 30. The presence of mental state disorder between 18-30 years old was identified. Multiple potential confounders in childhood were included in the analysis.

RESULTS

Neuroticism at fourteen was significantly correlated with multiple environmental exposures whereas extroversion had relatively few associations. Regression analysis found that neuroticism at 14 predicted depression, anxiety, suicidality and overall mental health problems at 30 as well as poor self-esteem but not relationship quality or wellbeing. Extroversion at 14 predicted alcohol and drug dependence and overall mental health problems, but also predicted improved social wellbeing, self-esteem and relationship quality at 30.

CONCLUSIONS

In this analysis extroversion interacts with significantly fewer environmental factors than neuroticism in predicting adult outcomes. Neuroticism at 14 years predicts poorer mental health outcomes in adulthood. Extroversion in childhood may be a protective factor in the development of mental disorder other than alcohol use disorders. Extroverted adolescents have more positive social outcomes at 30 years.

Measuring recovery related outcomes: a psychometric investigation of the recovery markers inventory

The concept of recovery can be operationalized from either the point of view of the consumer or from the perspective of the provider of services. The Recovery Markers Inventory (RMI) was created to assess recovery-related factors (i.e., actions/events associated with consumer's recovery) from the provider's perspective. Evidence, which established the psychometric properties of the RMI, was obtained through the use of: (a) construct validity (i.e., confirmatory factor analysis and Rasch principal components analysis of residuals); (b) concurrent validity (i.e., the calculation of Pearson correlations between the RMI and other recovery-oriented instruments); and (c) reliability (i.e., Rasch Partial Credit models). Evidence presented in this article shows that the RMI scale is unidimensional, has an adequate level of correlation, and acceptable reliability. The current analysis provides evidence to support the RMI as a valid, reliable measure of recovery-related factors, which can complement consumer based instruments in the assessment of changes in recovery.

Using multiple views of family dynamics to predict the mental health of individuals with TBI and their caregivers in Mexico

PURPOSE

To examine differences in ratings of family dynamics between individuals with traumatic brain injury (TBI) and their family caregivers in Mexico, as well as differences in the prediction of caregiver and patient mental health outcomes from those ratings.

METHOD

Forty-two patient-caregiver dyads (n = 84) from the National Institute of Rehabilitation in México City participated in a comprehensive evaluation of their family dynamics and mental health.

RESULTS

Patients' and caregivers' ratings of family dynamics were significantly correlated and did not differ across five of six types of family dynamics, but caregivers rated their family's level of empathy higher than patients, p < 0.001. Additionally, all patient and caregiver ratings of family dynamics were significantly correlated. Patients', caregivers', and combined (using structural equation modeling latent constructs) ratings of family dynamics robustly predicted four times as many caregiver mental health outcomes as patient mental health outcomes.

CONCLUSIONS

Family dynamics influence both TBI patient and caregiver mental health but much more so in caregivers. Research on families of individuals with TBI in Mexico should incorporate both patient and caregiver perspectives to more comprehensively depict the environment in which TBI rehabilitation occurs.

Lessons learned from child sexual abuse research: prevalence, outcomes, and preventive strategies

Although child sexual abuse (CSA) is recognized as a serious violation of human well-being and of the law, no community has yet developed mechanisms that ensure that none of their youth will be sexually abused. CSA is, sadly, an international problem of great magnitude that can affect children of all ages, sexes, races, ethnicities, and socioeconomic classes. Upon invitation, this current publication aims at providing a brief overview of a few lessons we have learned from CSA scholarly research as to heighten awareness of mental health professionals on this utmost important and widespread social problem. This overview will focus on the prevalence of CSA, the associated mental health outcomes, and the preventive strategies to prevent CSA from happening in the first place.

Mental health outcomes of cocaine-exposed children at 6 years of age

OBJECTIVE

To assess 6-year-old cocaine- and noncocaine-exposed children's mental health outcomes controlling for potential confounders.

METHODS

The sample consisted of 322 children [169 cocaine exposed (CE) and 153 noncocaine exposed (NCE)] enrolled in a longitudinal study since birth. At age 6, children were assessed for mental health symptoms using the Dominic Interactive (DI), a child self-report measure, and the Child Behavior Checklist (CBCL), a caregiver report of behavioral problems.

RESULTS

CE children were more likely to self-report symptoms in the probable clinical range for oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD). In contrast, prenatal cocaine exposure was not related to child behavior based on the CBCL. After control for exposure, CE children in adoptive or foster care were rated as having more problems with aggression, externalizing behaviors, and total behavioral problems than NCE children and CE children in maternal or relative care. Also, CE children in adoptive or foster care self-reported more externalizing symptoms than CE children in maternal or relative care and NCE children. Findings could not be attributed to caregiver intelligence or depressive symptoms, or to the quality of the home environment.

CONCLUSIONS

CE children report more symptoms of ODD and ADHD than nonexposed children. Adoptive or foster caregivers rated their CE children as having more behavioral problems than did maternal or relative caregivers of CE children or parents of NCE children. Although further studies are needed to understand the basis for the more negative ratings by adoptive or foster caregivers of their CE children, the self-report of CE children indicates a need for psychological interventions.