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Kajanoja J, Valtonen J. A Descriptive Diagnosis or a Causal Explanation? Accuracy of Depictions of Depression on Authoritative Health Organization Websites. Psychopathology 2024:1-10. [PMID: 38865990 DOI: 10.1159/000538458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/12/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Psychiatric diagnoses are descriptive in nature, but the lay public commonly misconceives them as causal explanations. It is not known whether this logical error, a form of circular reasoning, can sometimes be mistakenly reinforced by health authorities themselves. In this study, we investigated the prevalence of misleading causal descriptions of depression in the information provided by authoritative mental health organizations on widely accessed internet sites. METHODS We searched for popular websites managed by leading mental health organizations and conducted a content analysis to evaluate whether they presented depression accurately as a description of symptoms, or inaccurately as a causal explanation. RESULTS Most websites used language that inaccurately described depression as a causal explanation to depressive symptoms. CONCLUSION Leading professional medical and psychiatric organizations commonly confound depression, a descriptive diagnostic label, with a causal explanation on their most prominently accessed informational websites. We argue that the scientifically inaccurate causal language in depictions of psychiatric diagnoses is potentially harmful because it leads the public to misunderstand the nature of mental health problems. Mental health authorities providing psychoeducation should clearly state that psychiatric diagnoses are purely descriptive to avoid misleading the public.
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Affiliation(s)
- Jani Kajanoja
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Valtonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Theatre Academy, University of the Arts Helsinki, Helsinki, Finland
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2
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Sturmberg JP, Martin JH, Tramonti F, Kühlein T. The need for a change in medical research thinking. Eco-systemic research frames are better suited to explore patterned disease behaviors. Front Med (Lausanne) 2024; 11:1377356. [PMID: 38887671 PMCID: PMC11180740 DOI: 10.3389/fmed.2024.1377356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
Many practicing physicians struggle to properly evaluate clinical research studies - they either simply do not know them, regard the reported findings as 'truth' since they were reported in a 'reputable' journal and blindly implement these interventions, or they disregard them as having little pragmatic impact or relevance to their daily clinical work. Three aspects for the latter are highlighted: study populations rarely reflect their practice population, the absolute average benefits on specific outcomes in most controlled studies, while statistically significant, are so small that they are pragmatically irrelevant, and overall mortality between the intervention and control groups are unaffected. These observations underscore the need to rethink our research approaches in the clinical context - moving from the predominant reductionist to an eco-systemic research approach will lead to knowledge better suited to clinical decision-making for an individual patient as it takes into account the complex interplay of multi-level variables that impact health outcomes in the real-world setting.
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Affiliation(s)
- Joachim P. Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- International Society for Systems and Complexity Sciences for Health, Waitsfield, VT, United States
| | - Jennifer H. Martin
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Francesco Tramonti
- Department of Mental Health, Azienda USL Toscana Nordovest & Istituto di Psicoterapia Relazionale, Pisa, Italy
| | - Thomas Kühlein
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
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3
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van Dellen E. Precision psychiatry: predicting predictability. Psychol Med 2024; 54:1500-1509. [PMID: 38497091 DOI: 10.1017/s0033291724000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Precision psychiatry is an emerging field that aims to provide individualized approaches to mental health care. An important strategy to achieve this precision is to reduce uncertainty about prognosis and treatment response. Multivariate analysis and machine learning are used to create outcome prediction models based on clinical data such as demographics, symptom assessments, genetic information, and brain imaging. While much emphasis has been placed on technical innovation, the complex and varied nature of mental health presents significant challenges to the successful implementation of these models. From this perspective, I review ten challenges in the field of precision psychiatry, including the need for studies on real-world populations and realistic clinical outcome definitions, and consideration of treatment-related factors such as placebo effects and non-adherence to prescriptions. Fairness, prospective validation in comparison to current practice and implementation studies of prediction models are other key issues that are currently understudied. A shift is proposed from retrospective studies based on linear and static concepts of disease towards prospective research that considers the importance of contextual factors and the dynamic and complex nature of mental health.
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Affiliation(s)
- Edwin van Dellen
- Department of Psychiatry and University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
- Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
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4
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Mirbahaeddin E, Chreim S. Transcending technology boundaries and maintaining sense of community in virtual mental health peer support: a qualitative study with service providers and users. BMC Health Serv Res 2024; 24:510. [PMID: 38658968 PMCID: PMC11040832 DOI: 10.1186/s12913-024-10943-y] [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: 01/12/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND This qualitative study explores the experiences of peer support workers (PSWs) and service users (or peers) during transition from in-person to virtual mental health services. During and following the COVID-19 pandemic, the need for accessible and community-based mental health support has become increasingly important. This research aims to understand how technological factors act as bridges and boundaries to mental health peer support services. In addition, the study explores whether and how a sense of community can be built or maintained among PSWs and peers in a virtual space when connections are mediated by technology. This research fills a gap in the literature by incorporating the perspectives of service users and underscores the potential of virtual peer support beyond pandemic conditions. METHODS Data collection was conducted from a community organization that offers mental health peer support services. Semi-structured interviews were conducted with 13 employees and 27 service users. Thematic analysis was employed to identify key themes and synthesize a comprehensive understanding. RESULTS The findings highlight the mental health peer support needs that were met through virtual services, the manifestation of technology-based boundaries and the steps taken to remove some of these boundaries, and the strategies employed by the organization and its members to establish and maintain a sense of community in a virtual environment marked by physical distancing and technology-mediated interrelations. The findings also reveal the importance of providing hybrid services consisting of a mixture of in person and virtual mental health support to reach a broad spectrum of service users. CONCLUSIONS The study contributes to the ongoing efforts to enhance community mental health services and support in the virtual realm. It shows the importance of virtual peer support in situations where in-person support is not accessible. A hybrid model combining virtual and in-person mental health support services is recommended for better accessibility to mental health support services. Moreover, the importance of organizational support and of equitable resource allocation to overcome service boundaries are discussed.
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Affiliation(s)
- Elmira Mirbahaeddin
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, K1N 6N5, Ottawa, ON, Canada.
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, K1N 6N5, Ottawa, ON, Canada
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5
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Maas IL, Bohlken MM, Gangadin SS, Rosema BS, Veling W, Boonstra N, de Haan L, Begemann MJH, Koops S. Personal recovery in first-episode psychosis: Beyond clinical and functional recovery. Schizophr Res 2024; 266:32-40. [PMID: 38367610 DOI: 10.1016/j.schres.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/24/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The concept of personal recovery after psychotic illness focuses more on patients' social and existential needs compared to traditional outcome measures including clinical and functional recovery. This research aims to contribute to a broad framework on (personal) recovery and associated factors. METHODS Data from 203 persons with symptomatic remission of their first-episode psychosis from the ongoing HAMLETT study were analyzed. To determine the relative importance of several biological, clinical, psychological, and social factors in explaining personal recovery as measured by the Recovery Assessment Scale (RAS), partial Spearman correlations (controlling for clinical recovery (PANSS) and functional recovery (WHODAS 2.0)) and a bootstrapped multiple regression were performed. Indirect effects on personal recovery within these factors, clinical recovery, and functional recovery were explored using a regularized partial correlation network. RESULTS Of the factors that explained personal recovery beyond the effects of clinical and functional recovery, social support was the strongest predictor, followed by self-esteem, internalized stigma, and insecure attachment, collectively explaining 48.2 % of the variance. Anhedonia/apathy showed a trend towards a negative correlation. Age at onset, sex, early trauma/neglect, cognition, and being married/cohabiting did not significantly correlate with personal recovery. The network (n = 143) was consistent with these findings and indicated possible mediation pathways for early trauma/neglect, insecure attachment, cognition, and being married/cohabiting. CONCLUSIONS Personal recovery is an important addition to traditional measures of outcome after psychosis. Various quality of life indicators, such as self-esteem and social support, explain variance in personal recovery over clinical and functional recovery.
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Affiliation(s)
- Isolde L Maas
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc M Bohlken
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Shiral S Gangadin
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bram-Sieben Rosema
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nynke Boonstra
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; NHL Stenden, University of Applied Sciences, Leeuwarden, the Netherlands; KieN VIP Mental Health Care Services, Leeuwarden, the Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Marieke J H Begemann
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sanne Koops
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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6
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Bouwhuis-Van Keulen AJ, Koelen J, Eurelings-Bontekoe L, Hoekstra-Oomen C, Glas G. The evaluation of religious and spirituality-based therapy compared to standard treatment in mental health care: A multi-level meta-analysis of randomized controlled trials. Psychother Res 2024; 34:339-352. [PMID: 37615090 DOI: 10.1080/10503307.2023.2241626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Psychotherapies are increasingly incorporating spiritual and religious systems of belief and practice, which aligns with recent developments toward person-centered treatments. The main objective of this meta-analysis was to compare the efficacy of a religion and spiritually-based (R/S) therapy to non-R/S treatments. METHOD A multi-level meta-analysis was conducted to compare randomized controlled studies of the efficacy between R/S-based and regular treatments in mental health care setting. Inclusion criteria were diagnosis, psychotherapeutic treatment, and explicitly religion/spirituality therapy. Outcome was assessed for symptoms and for functioning separately, and combined. We also examined several moderators, such as type of comparison, outcome domain, and diagnosis. RESULTS Overall effect sizes obtained from 23 studies and 27 comparison groups indicated that a R/S treatment is moderately more efficacious compared to regular treatments at posttreatment (g = .52, p < .01) and at follow-up (g = .72, p < .01) (only available for symptoms). Results were similar for symptoms (g = .44, p < .01) and functioning (g = .62, p < .01). CONCLUSION In patients with a strong religious and spiritual affiliation, treatments with a focus on religious and spiritual issues are more efficacious than non-R/S-based therapy. Limitations as well as future directions are discussed.
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Affiliation(s)
| | - Jurrijn Koelen
- Faculty of Behavioural, Management and Social Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | | | | | - Gerrit Glas
- Faculty of Humanities, Department of Philosophy, VUmc Amsterdam, Amsterdam, The Netherlands
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Clercx M, van Pinxteren L. Don't Beat Around the Bush! The Relationship Between Forensic Vigilance and Communication Style. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024:306624X241228214. [PMID: 38297913 DOI: 10.1177/0306624x241228214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
The field of forensic mental healthcare is unique in several ways. Forensic vigilance is a specialty needed by forensic mental health professionals, consisting of professional forensic psychiatric knowledge, knowledge of individual patients, environmental observations, and clinical judgment. Though communication seems to play an important role in forensic vigilance, it is still unknown which communication styles are related to forensic vigilance, if any. In the current study, we examined if certain communication styles are related to forensic vigilance by means of an online survey among forensic mental health professionals. In total 138 Dutch forensic psychiatric professionals participated in the survey. The expressive and precise communication styles positively predict forensic vigilance, while the emotional and manipulative communication styles show a negative relationship with forensic vigilance. Findings of the present study further the understanding of the construct of forensic vigilance. The findings presented here may give rise to attention for specific manners of communication in supervision and training programs. The current study represents the first effort to study the relationship between communication styles and forensic vigilance.
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Affiliation(s)
- Maartje Clercx
- Forensic Psychiatric Centre (FPC) de Rooyse Wissel, Venray, The Netherlands
- Radboud University, Nijmegen, The Netherlands
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Zabelski S, Hollander M, Alexander A. Addressing Inequities in Access to Mental Healthcare: A Policy Analysis of Community Mental Health Systems Serving Minoritized Populations in North Carolina. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01344-8. [PMID: 38285082 DOI: 10.1007/s10488-024-01344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
Racial and ethnic minoritized uninsured populations in the United States face the greatest barriers to accessing mental healthcare. Historically, systems of care in the U.S. were set up using inadequate evidence at the federal, state, and local levels, driving inequities in access to quality care for minoritized populations. These inequities are most evident in community-based mental health services, which are partially or fully funded by federal programs and predominantly serve historically minoritized groups. In this descriptive policy analysis, we outline the history of federal legislative policies that have dictated community mental health systems and how these policies were implemented in North Carolina, which has a high percentage of uninsured communities of color. Several gaps between laws passed in the last 60 years and research on improving inequities in access to mental health services are discussed. Recommendations to expand/fix these policies include funding accurate data collection and implementation methods such as electronic health record (EHR) systems to ensure policies are informed by extensive data, implementation of evidence-informed and culturally sensitive interventions, and prioritizing preventative services that move past traditional models of mental healthcare.
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Affiliation(s)
- Sasha Zabelski
- Department of Public Health Sciences, University of North Carolina, Charlotte, USA.
| | - Mara Hollander
- Department of Public Health Sciences, University of North Carolina, Charlotte, USA
| | - Apryl Alexander
- Department of Public Health Sciences, University of North Carolina, Charlotte, USA
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9
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Xenaki LA, Dimitrakopoulos S, Selakovic M, Stefanis N. Stress, Environment and Early Psychosis. Curr Neuropharmacol 2024; 22:437-460. [PMID: 37592817 PMCID: PMC10845077 DOI: 10.2174/1570159x21666230817153631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 08/19/2023] Open
Abstract
Existing literature provides extended evidence of the close relationship between stress dysregulation, environmental insults, and psychosis onset. Early stress can sensitize genetically vulnerable individuals to future stress, modifying their risk for developing psychotic phenomena. Neurobiological substrate of the aberrant stress response to hypothalamic-pituitary-adrenal axis dysregulation, disrupted inflammation processes, oxidative stress increase, gut dysbiosis, and altered brain signaling, provides mechanistic links between environmental risk factors and the development of psychotic symptoms. Early-life and later-life exposures may act directly, accumulatively, and repeatedly during critical neurodevelopmental time windows. Environmental hazards, such as pre- and perinatal complications, traumatic experiences, psychosocial stressors, and cannabis use might negatively intervene with brain developmental trajectories and disturb the balance of important stress systems, which act together with recent life events to push the individual over the threshold for the manifestation of psychosis. The current review presents the dynamic and complex relationship between stress, environment, and psychosis onset, attempting to provide an insight into potentially modifiable factors, enhancing resilience and possibly influencing individual psychosis liability.
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Affiliation(s)
- Lida-Alkisti Xenaki
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave., Athens, 115 28, Greece
| | - Stefanos Dimitrakopoulos
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave., Athens, 115 28, Greece
| | - Mirjana Selakovic
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave., Athens, 115 28, Greece
| | - Nikos Stefanis
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave., Athens, 115 28, Greece
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Jansson I, Thörne K, Masterson D. Beyond conventional healthcare for mental health problems: Experiences of existential group conversations. Scand J Occup Ther 2024; 31:2244547. [PMID: 37552998 DOI: 10.1080/11038128.2023.2244547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Mental health problems (MHP) are a major public health challenge. Conventional healthcare has shown limitation on reducing MHP and there is a call for offering methods beyond healthcare as well as improve access to healthcare. AIMS To explore experiences among people having MHP of (i) taking part in existential conversations in groups beyond conventional healthcare and (ii) seeking and receiving conventional healthcare. MATERIALS AND METHODS Four focus group interviews were conducted after finishing existential conversations in groups. Data was analyzed following thematic analysis. RESULTS The theme Access to a community for exploration and acceptance describes communication through impressions and expressions together with others. A reflective perspective on everyday life, describes re-evaluation through reflection. Within the theme Experiences of healthcare related encounters, referring to the second aim, participants recollected feelings of disconnectedness, difficulties verbalizing MHP and dealing with rigid, standardized measures. CONCLUSION Existential conversations in group may contribute to a more reflected doing in accordance with one's own values as well as improved mental health literacy. Design and measures within healthcare need to explicitly address MHP and consider individual's own preferences. SIGNIFICANCE This study contributes to understanding of coping with MHP in everyday life from an existential perspective.
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Affiliation(s)
- Inger Jansson
- Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Karin Thörne
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Futurum, Region Jönköping Council, Jönköping, Sweden
| | - Daniel Masterson
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
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van Os J, Scheepers F, Milo M, Ockeloen G, Guloksuz S, Delespaul P. "It has to be better, otherwise we will get stuck." A Review of Novel Directions for Mental Health Reform and Introducing Pilot Work in the Netherlands. Clin Pract Epidemiol Ment Health 2023; 19:e17450179271206. [PMID: 38680529 PMCID: PMC11046893 DOI: 10.2174/0117450179271206231114064736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 05/01/2024]
Abstract
Background The current state of mental health care in the Netherlands faces challenges such as fragmentation, inequality, inaccessibility, and a narrow specialist focus on individual diagnosis and symptom reduction. Methods A review suggests that in order to address these challenges, an integrated public health approach to mental health care that encompasses the broader social, cultural, and existential context of mental distress is required. Results A Mental Health Ecosystem social trial seeks to pilot such an approach in the Netherlands, focusing on empowering patients and promoting collaboration among various healthcare providers, social care organizations, and peer-support community organizations, working together in a regional ecosystem of care and committed to a set of shared values. In the ecosystem, mental health problems are examined through the prism of mental variation in context whilst scaling up the capacity of group-based treatment and introducing a flexible and modular approach of (2nd order) treatment by specialists across the ecosystem. The approach is to empower naturally available resources in the community beyond professionally run care facilities. Digital platforms such as psychosenet.nl and proud2bme.nl, which complement traditional mental health care services and enhance public mental health, will be expanded. The capacity of recovery colleges will be increased, forming a national network covering the entire country. GEM will be evaluated using a population-based approach, encompassing a broad range of small-area indicators related to mental health care consumption, social predictors, and clinical outcomes. The success of GEM relies heavily on bottom-up development backed by stakeholder involvement, including insurers and policy-making institutions, and cocreation. Conclusion By embracing a social trial and leveraging digital platforms, the Dutch mental health care system can overcome challenges and provide more equitable, accessible, and high-quality care to individuals.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Floortje Scheepers
- Department of Psychiatry, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Michael Milo
- Milo Health Care Connector and Change Management Consultant, Berlagehof 14, 1067 NB Amsterdam, The Netherlands
| | - Gijs Ockeloen
- Reframing Studio Design Introspector, Bilderdijkkade 50 A11053 VN Amsterdam, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Mondriaan Mental Health Trust, 6401 CX Heerlen, The Netherlands
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van Wezel MMC, Muusse C, van de Mheen D, Wijnen B, den Hollander W, Kroon H. What do we not know (yet) about recovery colleges? A study protocol on their (cost-)effectiveness, mechanisms of action, fidelity and positioning. BMC Psychiatry 2023; 23:816. [PMID: 37940915 PMCID: PMC10633919 DOI: 10.1186/s12888-023-05293-8] [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: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Recovery Colleges (RCs) have spread across the globe as a new way of supporting people with mental vulnerabilities in their recovery journey. RCs focus on 'learning' rather than 'curing' and in that line facilitate a transition from being a passive, dependent patient/client to an active, empowered student learning to live life, despite vulnerabilities. Peer support and co-creation are central in RCs, as peers learn from each other by sharing personal experiences with mental vulnerabilities in an accessible, inspiring and stimulating atmosphere. The implementation of RCs is highly encouraged internationally, and as a result RCs and related self-help initiatives increasingly emerge. However, high-quality research on RCs is scarce and there is a call for thorough investigation of (cost-)effectiveness, mechanisms of action, cross-border fidelity and positioning of RCs. In response, this research project aims to fill these gaps. METHODS This research project entails (1) a prospective quasi-experimental effectiveness study and economic evaluation, (2) a multifaceted qualitative study to elaborate on the mechanisms of action of RCs for those involved (3) a study to develop a (Dutch) Fidelity Measure of Recovery Colleges, and (4) an organisational case study to describe the positioning of RCs in relation to other mental health care services and community-based initiatives. Following the ideals of co-creation and empowerment in RCs we conduct this research project in co-creation with RC students from Enik Recovery College in Utrecht, the Netherlands. DISCUSSION This research project will lead to one of the first longitudinal controlled quantitative evaluations of both cost-effectiveness and effectiveness of RC attendance in a broad sense (beyond attending courses alone). Moreover, we will gather data on a micro level (i.e., impact on RC students), meso level (i.e., organisational fidelity) and macro level (i.e., positioning in the care and support domain), capturing all important perspectives when scrutinizing the impact of complex systems. Finally, we will demonstrate the validity and value of embracing experiential knowledge in science as a complementary source of information, leading to a more profound understanding of what is researched. TRIAL REGISTRATION The prospective quasi-experimental study has been pre-registered at clinicaltrails.gov (#NCT05620212).
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Affiliation(s)
- Marloes M C van Wezel
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg, the Netherlands.
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, the Netherlands.
| | - Christien Muusse
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, the Netherlands
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg, the Netherlands
| | - Ben Wijnen
- Department of Epidemiology, Data, Evaluation & Monitoring, Trimbos Institute, Utrecht, the Netherlands
- Center of Economic Evaluation & Machine Learning, Trimbos Institute, Utrecht, the Netherlands
| | - Wouter den Hollander
- Department of Epidemiology, Data, Evaluation & Monitoring, Trimbos Institute, Utrecht, the Netherlands
| | - Hans Kroon
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg, the Netherlands
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, the Netherlands
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Martinelli A, Dal Corso E, Pozzan T, Cristofalo D, Bonetto C, Ruggeri M. Addressing Challenges in Residential Facilities: Promoting Human Rights and Recovery While Pursuing Functional Autonomy. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2023; 6:12-22. [PMID: 38510484 PMCID: PMC10948939 DOI: 10.1176/appi.prcp.20230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 03/22/2024] Open
Abstract
Objective Italian residential facilities (RFs) aim to promote human rights and recovery for individuals with severe mental disorders. Italian RFs can be distinguished into five main types: high-intensity rehabilitation (RF1), medium-intensity rehabilitation (RF2), medium-level support (RF3.1), high-level support (RF3.2), low-level support (RF3.3). This study aimed to assess the effectiveness of Italian RFs in achieving functional autonomy while upholding human rights and recovery. Methods Data on socio-demographics, clinical information, patient and staff assessments of functional autonomy, types of interventions, and RF performance in various domains were collected in a pilot study with a cross-sectional design. Descriptive and inferential analyses were conducted. Results Twelve RFs and 113 patients participated, with varying proportions in each RF type. RF1 patients were the oldest (p < 0.001) with the lowest functional autonomy (p < 0.001), while RF2 patients were the youngest (p < 0.001) with the lowest hospitalization rate (p < 0.001). RF3.1 patients had the highest employment rate (p = 0.024), while RF3.2 had the lowest employment rate (p = 0.024) and the longest service contact (p < 0.001). RF3.3 users had the highest functional autonomy (p < 0.001). The highest functional autonomy was in self-care which received the highest focus in objectives and interventions. Patients rated their functional autonomy higher than professionals (p < 0.001). RFs excelled in the "human rights" and "social interface" domains but performed poorly in "recovery-based practice," with RF1 having the lowest performance and RF3.3 the highest. Conclusions This pilot study suggests that Italian RFs generally aligne with their mission and human rights principles, but personalizing interventions and implementing recovery-oriented practices face challenges.
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Affiliation(s)
| | | | - Tecla Pozzan
- Section of PsychiatryVerona Hospital TrustAOUIVeronaItaly
| | - Doriana Cristofalo
- Dipartimento di Neuroscienze, Biomedicina e MovimentoUniversità di VeronaVeronaItaly
| | - Chiara Bonetto
- Dipartimento di Neuroscienze, Biomedicina e MovimentoUniversità di VeronaVeronaItaly
| | - Mirella Ruggeri
- Section of PsychiatryVerona Hospital TrustAOUIVeronaItaly
- Dipartimento di Neuroscienze, Biomedicina e MovimentoUniversità di VeronaVeronaItaly
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14
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Ahmed MM, John J. Perceptions of mental health services among the children who are in conflict with the law in Jammu and Kashmir. Glob Ment Health (Camb) 2023; 10:e81. [PMID: 38161739 PMCID: PMC10755411 DOI: 10.1017/gmh.2023.70] [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: 01/05/2023] [Revised: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 01/03/2024] Open
Abstract
Background: Due to the Jammu and Kashmir conflict, many teenagers are involved in disputes with the law. The conflict made generations suffer for decades. Such children made the mobs; being involved in life-threatening situations and the risk they confront develop psychiatric disorders. As a result of the various tense conditions when applied in multiple anti-social activities, aberrant children sent to correctional homes have to encounter numerous psychological disorders. Aim: The motive of the study is to explore the level of awareness, availability of services, stigma and obstacles to seeking assistance. Method: Due to the open-ended interview questions and a small sample size of 15 respondents, this study employed a qualitative methodology - a thematic analysis was done. Results: The findings revealed that, although the stigma is not publicly acknowledged, children who break the law and seek mental health services (MHS) are stigmatised. It was also shown that minor offenders fear that when they receive services provided by the staff of the observation home (OH), there will be a violation of their privacy and fear unforeseen repercussions. Conclusion: Collaborative action must proactively raise appropriate awareness to lessen the stigma linked with mental health problems, especially regarding MHS among these teenagers.
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Affiliation(s)
- Mohd Manshoor Ahmed
- Research Scholar, Department of Social Work, Central University of Kerala, Periye, Kerala
| | - Jilly John
- Assistant Professor, Department of Social Work, Central University of Kerala, Periye, Kerala
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Cross S, Nicholas J, Mangelsdorf S, Valentine L, Baker S, McGorry P, Gleeson J, Alvarez-Jimenez M. Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study. JMIR Form Res 2023; 7:e49846. [PMID: 37921858 PMCID: PMC10656668 DOI: 10.2196/49846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/06/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success. OBJECTIVE The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success. METHODS We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks. RESULTS The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs. CONCLUSIONS The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact.
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Affiliation(s)
- Shane Cross
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Jennifer Nicholas
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Shaminka Mangelsdorf
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Lee Valentine
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | - Patrick McGorry
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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16
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Grandjean L, Kolly S, Kramer U. Predictors of Effects in Brief Psychiatric Treatment for Borderline Personality Disorder. J Pers Disord 2023; 37:741-750. [PMID: 38038656 DOI: 10.1521/pedi.2023.37.6.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
If evidence points to the equal efficacy of all bona fide treatments for borderline personality disorder (BPD) in general, it may not necessarily be true for a specific individual, nor do such general conclusions help in the triage of clients in clinical services. We investigated potential therapy outcome predictors for participants with a BPD diagnosis (N = 99). They were assessed on scales including the Outcome Questionnaire-45.2 (OQ-45), the Inventory of Interpersonal Problems-64, and the Borderline Symptom List. Our analyses revealed that individuals with low levels of symptom distress at intake had the smallest change in total OQ-45 score over the course of brief treatment, while the individuals with high levels of symptom distress had a mean large change in total score (-23). We observed that individuals with high symptom loads AND low levels of interpersonal problems at intake seemed to have the best progress.
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Affiliation(s)
- Loris Grandjean
- Institute of Psychotherapy, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Stéphane Kolly
- General Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Ueli Kramer
- Institute of Psychotherapy, General Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, and University of Lausanne, Switzerland, Department of Psychology, University of Windsor, Ontario, Canada
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17
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Cleary M, West S, Hungerford C. Four Steps to Add Critical Thinking to the Mental Health Nursing Toolkit. Issues Ment Health Nurs 2023; 44:1167-1170. [PMID: 37319420 DOI: 10.1080/01612840.2023.2212813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
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18
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Lorenz-Artz K, Bierbooms J, Bongers I. Unraveling complexity in changing mental health care towards person-centered care. Front Psychiatry 2023; 14:1250856. [PMID: 37779631 PMCID: PMC10536252 DOI: 10.3389/fpsyt.2023.1250856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background Mental health care (MHC) needs to shift towards person-centered care to better meet people's individual needs. Open Dialogue (OD) is well-aligned with this perspective and brings it into practice. This study focuses on exploring the change process within a pilot project involving three MHC teams as they transition to a person-centered OD practice. Our aim is to identify and reflect on the challenges faced by MHC professionals in adopting person-centered care, and shedding light on the underlying complexity of these challenges. By gaining a better understanding of these obstacles, we hope to contribute to the adoption of the person-centered approach in MHC practice. Methods Our research employed a qualitative design, involving a total of 14 semi-structured interviews with MHC professionals who were either trained in OD, OD trainees, or MHC professionals without OD training. To analyze the data, we utilized a hybrid approach that combined deductive - and inductive thematic analysis. Results We identified four distinctive challenges: (1) understanding and knowledge transfer, (2) (inter)personal process, (3) emotional discomfort, and (4) the need for multi-stakeholder participation and support. In practice, these challenges intersect and the appearance of and relationships between these challenges are not linear or disentangleable. Conclusion Upon careful consideration of these interdependent challenges, it became evident that embedding a person-centered approach like OD brings about systemic change, leading to an unfamiliar situation X. The research findings indicated that understanding and conveying the concept of person-centered care in practical settings poses significant challenges. The field of knowledge management helps to capture the complexity of understanding and transferring this knowledge. The change process necessitates an (inter)personal process and elicits emotional discomfort, as person-centered OD practice confronts a deeply entrenched paradigm in MHC. Achieving a shared understanding of person-centered care requires dedicated time and attention, while introducing this approach prompts broader discussions on underlying values and human rights in MHC. Current implementation efforts may underestimate or overlook these underlying values, but initiating an open dialogue can serve as an initial step in addressing the complexities.
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Affiliation(s)
- Karin Lorenz-Artz
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Mental Health Care Institute, Eindhoven, Netherlands
| | - Joyce Bierbooms
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Inge Bongers
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Mental Health Care Institute, Eindhoven, Netherlands
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Cairns AJJ, Kelly J, Taylor CDJ. Assessing the delivering of iMAgery-focused therapy for PSychosis (iMAPS) via telehealth. Psychol Psychother 2023; 96:678-696. [PMID: 37002818 DOI: 10.1111/papt.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES To examine the feasibility and acceptability of a novel telehealth (video-conferencing software and telephone calls) imagery-based therapeutic intervention for people experiencing persecutory delusions. Utilising a multiple baseline case series design and exploring imagery-focused therapy for psychosis (iMAPS). DESIGN A non-concurrent A-B multiple baseline design was used. METHODS Participants experiencing persecutory delusions and self-reporting a psychosis or schizophrenia-spectrum diagnosis were recruited through online adverts. On completion of assessments, participants were randomly assigned to multiple baseline assessments, of between three and five sessions. Six therapy sessions followed, consisting of imagery formulation, safe-place imagery creation, compassionate imagery, imagery manipulation and rescripting. Participants completed pre- and post-measures and sessional measures via an online survey software or in semi-structured interviews. Two weeks post-intervention, a final measure was completed exploring any potential adverse effects of psychotherapy. RESULTS Five female participants completed all baseline and therapeutic sessions, suggesting the therapy was and mode of delivery was feasible and acceptable. Results indicate strong effect sizes across PANSS positive subscale and mood, as well as participants reporting a clinically significant change in at least one measure, for example, PSYRATS. All participants reported a reduction in the realness and compelling nature of distressing imagery. CONCLUSIONS Results suggest delivering a telehealth imagery-focused therapy is acceptable and feasibly delivered via telehealth. A control group and blinding of assessments would strengthen the methodological limitations present.
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Affiliation(s)
- Aimee J J Cairns
- Clinical Psychology, Lancaster University, Health Innovation Campus, Bailrigg, Lancaster, LA1 4YW, UK
| | - James Kelly
- Clinical Psychology, Lancaster University, Health Innovation Campus, Bailrigg, Lancaster, LA1 4YW, UK
- North Manchester General Hospital, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Christopher D J Taylor
- Community Mental Health Team, Pennine Care NHS Foundation Trust, Humphrey House, Angouleme Way, Bury, Bl9 0EQ, UK
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
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Vella C, Berry C, Easterbrook MJ, Bibby-Jones AM, Michelson D, Bogen-Johnston L, Fowler D. Trialling an optimised social groups intervention in services to enhance social connectedness and mental health in vulnerable young people (TOGETHER): Study protocol for a feasibility randomised controlled trial. PLoS One 2023; 18:e0288676. [PMID: 37582069 PMCID: PMC10426917 DOI: 10.1371/journal.pone.0288676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Calls have been made to rethink the mental health support currently available for young people. This study aims to help re-focus and reduce the inaccessibility of mental health services by offering an adapted version of a theoretically-driven, evidence-based, guided psychosocial intervention known as 'Groups 4 Health' (G4H). To date, the G4H intervention has mainly been trialled in Australia, with promising positive effects on social connection, mental health and well-being. The present study examines the feasibility of running a randomised controlled trial when delivering the G4H intervention for young people in the UK. METHODS The TOGETHER study is a feasibility randomised controlled trial of an adapted version of the G4H intervention. Participants are aged 16-25, currently experiencing mental health difficulties and recruited from mental health services. The target sample size is 30, with 15 in each trial arm. Participants are randomly allocated to either G4H plus treatment as usual, or treatment as usual alone. The primary outcomes of interest are the feasibility of recruitment, randomisation, data collection and retention to the study at 10 and 14 week follow up, as well as the acceptability, and accessibility of the study protocol and G4H intervention. DISCUSSION The results of this study will indicate if further optimisation is required to improve the feasibility, acceptability and accessibility of the intervention and study protocol procedures as perceived by end users and practitioners. This offers a significant opportunity to support the local and national demand for accessible, innovative, and effective psychosocial youth mental health support. TRIAL REGISTRATION ISRCTN registry (ISRCTN12505807). Registration date: 11/04/2022.
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Affiliation(s)
- Claire Vella
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Clio Berry
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | - Anna-Marie Bibby-Jones
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, United Kingdom
| | - Daniel Michelson
- Department of Child and Adolescent Psychiatry, King’s College London, London, United Kingdom
| | - Leanne Bogen-Johnston
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, United Kingdom
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, United Kingdom
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21
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Lugg W, Levine A, Boyd R. Consumer? Views and preferences of people receiving public mental health care in Australia on the terms used to refer to them. Australas Psychiatry 2023; 31:435-440. [PMID: 37102589 DOI: 10.1177/10398562231172414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES To understand: a) whether adults receiving public mental health care were aware they were officially referred to as 'consumers' and, b) their views and preferences on the terms used to refer to them. METHODS Single-page, anonymous survey conducted across two community mental health services in Northern New South Wales (NNSW). Ethics approval obtained from the local research office. RESULTS 108 people completed the survey with a response rate of approximately 22%. The vast majority (77%) of respondents were not aware that they were officially referred to as 'consumers'. 32% of respondents disliked the term 'consumer' and 11% found it offensive. Half preferred the term 'patient', particularly when consulting a psychiatrist (55%). A small minority (5-7%) preferred the term 'consumer' for any care interaction. CONCLUSION Most respondents in this survey wished to be referred to as a 'patient' and a large proportion disliked being referred to as a 'consumer' or found it offensive. Further surveys should include broader sociodemographic and diagnostic/treatment variables. Official terms used to refer to people receiving public mental health care should be person-centred and evidence based.
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Affiliation(s)
- William Lugg
- Northern New South Wales Local Health District (NNSWLHD), Tweed Heads Community Mental Health Service, Tweed Heads, NSW, Australia; and
- Department of Psychiatry, The Alfred Hospital, Prahran, VIC, Australia
| | - Andrew Levine
- Department of Psychiatry, The Alfred Hospital, Prahran, VIC, Australia
| | - Robert Boyd
- NNSWLHD, Byron Community Mental Health Service, Byron Bay, NSW, Australia
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22
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Veldmeijer L, Terlouw G, Van Os J, Van Dijk O, Van 't Veer J, Boonstra N. The Involvement of Service Users and People With Lived Experience in Mental Health Care Innovation Through Design: Systematic Review. JMIR Ment Health 2023; 10:e46590. [PMID: 37490326 PMCID: PMC10410372 DOI: 10.2196/46590] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/10/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Mental health care faces challenges that not only necessitate innovation but also require the involvement of service users and people with lived experience in developing and evaluating mental health care services. As the development of digital interventions is becoming more prevalent, design approaches are increasingly finding their way into mental health. There is evidence that these approaches can successfully integrate user experience into mental health services. However, there is no clear overview of the studies conducted and the lessons learned concerning the involvement of service users and people with lived experience. OBJECTIVE In this systematic review, we aimed to provide an overview of the involvement of service users and people with lived experience in mental health care services through design approaches and to synthesize the advantages of design approaches in mental health care. METHODS The following 5 databases were searched for relevant abstracts: PsycINFO, PubMed, Web of Science, Scopus, and Embase. In addition, 2 health design journal archives, Design for Health and The Journal of Health Design, were searched. To categorize the results, we collected the reported added value from the included articles and conducted a thematic synthesis in which the themes were developed from the retrieved data. The themes were discussed, revised, and checked until saturation was achieved. RESULTS We included and categorized 33 papers. Most studies involved service users, primarily adults, and used various design approaches. Most of these studies aimed to design or evaluate digital interventions. Service users and people with lived experience were involved in different roles but never as decision makers. Studies that used co-design approaches exhibited the highest levels of involvement. Various added values were reported, including tailoring and testing interventions and digital interventions, improving engagement and collaboration, gathering the needs of stakeholders, and empowering participants as resourceful actors. The challenges reported were maintaining participants' continued participation throughout the study, managing the iterative nature of design, providing a safe space, balancing insights from design and medical science, and navigating design processes in medical environments. CONCLUSIONS This systematic review provides an overview of the studies that used design approaches to involve service users and people with lived experience in mental health care innovation. Design approaches have advantages in mental health care innovation, offering added value and having manageable challenges. Future studies using design approaches in mental health care should involve participants as partners and decision makers and report on collaboration in a systematic and clear manner.
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Affiliation(s)
- Lars Veldmeijer
- Department of Psychiatry, Utrecht University Medical Center, Utrecht, Netherlands
- Department of Healthcare and Welfare, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Gijs Terlouw
- Department of Healthcare and Welfare, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Jim Van Os
- Department of Psychiatry, Utrecht University Medical Center, Utrecht, Netherlands
| | - Olga Van Dijk
- NHL Stenden Library, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Job Van 't Veer
- Department of Healthcare and Welfare, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Nynke Boonstra
- Department of Psychiatry, Utrecht University Medical Center, Utrecht, Netherlands
- Department of Healthcare and Welfare, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
- KieN VIP Mental Health Care Services, Leeuwarden, Netherlands
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Clercx M, Peters-Scheffer N, Keulen-de Vos M, Schaftenaar P, Dekkers D, van Gerwen N, Klerk AD, Strijbos N, Didden R. Qualitative Analysis of Severe Incidents in Forensic Psychiatric Hospitals: Toward a Model of Forensic Vigilance. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023:306624X231188238. [PMID: 37477118 DOI: 10.1177/0306624x231188238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Forensic vigilance is a hypothesized specialty of forensic mental health professionals which seems to play a role in maintaining safety in forensic hospitals. It is unclear exactly how forensic vigilance relates to preventing incidents. We used standardized reports of severe incidents that occurred in forensic hospitals to investigate how forensic vigilance plays a role in the occurrence of incidents. Eight forensic psychiatric hospitals in the Netherlands contributed 69 anonymized incident reports, which were investigated by means of thematic analysis and interpretative phenomenological analysis. Analysis revealed five important themes. Four core skills needed by professionals, namely observation, integration, communication and action, which each need a number of prerequisites (e.g., knowledge). The fifth theme specifies that the professional needs to "connect the dots" meaningfully. This is a highly cyclical process in which the core four skills are steps. The process is unique to the forensic context in terms of how the "dots" are connected and weighed, and which risks need to be considered. We present a model of this process and prerequisites needed in professionals. This model can inform policy makers, aid assessment of and communication between forensic professionals and can form the basis of a training for forensic mental health professionals.
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Affiliation(s)
- Maartje Clercx
- Forensic Psychiatric Centre de Rooyse Wissel, Venray, The Netherlands
- Radboud University, Nijmegen, The Netherlands
| | | | - Marije Keulen-de Vos
- Forensic Psychiatric Centre de Rooyse Wissel, Venray, The Netherlands
- Radboud University, Nijmegen, The Netherlands
| | | | - Denise Dekkers
- Forensic Psychiatric Centre de Rooyse Wissel, Venray, The Netherlands
| | | | - Anke de Klerk
- Forensic Psychiatric Centre de Rooyse Wissel, Venray, The Netherlands
| | - Nicole Strijbos
- Forensic Psychiatric Centre de Rooyse Wissel, Venray, The Netherlands
| | - Robert Didden
- Radboud University, Nijmegen, The Netherlands
- Trajectum, Zwolle, The Netherlands
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Berger I, Bruineberg A, van Ewijk M, de Jong L, van der Hout M, van Weeghel J, van der Meer L. Developing a recovery-oriented intervention for people with severe mental illness and an intellectual disability: design-oriented action research. Front Psychiatry 2023; 14:1184798. [PMID: 37539326 PMCID: PMC10395094 DOI: 10.3389/fpsyt.2023.1184798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction Mild intellectual disability or borderline intellectual functioning (MID/BIF) are common in people with severe mental health problems (SMHP). Despite this, there is a lack of treatments adapted for this group of clients. Methods This qualitative study describes the development of a new intervention, guided by the principles of action research, for people with SMHP and MID/BIF and mental health professionals to help them talk about all aspects of the process of recovery. The intervention was developed in four cycles and in close cooperation with mental health professionals, experts by experience, other experts in the field of SMHP or MID/BIF, and clients. During all cycles there was a strong focus on the content of the intervention, exercises, understandable language, and drawings for visual support. Results This resulted in the intervention "Routes to Recovery," which covers both complaints and strengths, coping strategies, helpful (social) activities, and how to determine future steps in a recovery plan. Discussion Routes to Recovery is a first step in helping professionals and their clients with SMHP and MID/BIF to have a conversation about personal strengths and what the client needs to recover. Future research should investigate the effects of this intervention.
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Affiliation(s)
- Ingeborg Berger
- Department for Outpatients Severe Mental Health Services, Antes Parnassia Group, Rotterdam, Netherlands
| | - Anne Bruineberg
- Department for Outpatients Severe Mental Health Services, Antes Parnassia Group, Rotterdam, Netherlands
| | - Margot van Ewijk
- Department for Outpatients Severe Mental Health Services, Antes Parnassia Group, Rotterdam, Netherlands
| | - Levi de Jong
- Creative Media and Game Technology at Hogeschool Rotterdam, Rotterdam, Netherlands
| | - Michiel van der Hout
- Department for Outpatients Severe Mental Health Services, Antes Parnassia Group, Rotterdam, Netherlands
| | - Jaap van Weeghel
- Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Phrenos Center of Expertise on Severe Mental Illness, Utrecht, Netherlands
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
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Kohne ACJ, de Graauw LP, Leenhouts-van der Maas R, Van Os J. Clinician and patient perspectives on the ontology of mental disorder: a qualitative study. Front Psychiatry 2023; 14:1081925. [PMID: 37252148 PMCID: PMC10213209 DOI: 10.3389/fpsyt.2023.1081925] [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: 10/27/2022] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
Background Psychiatry may face an "identity crisis" regarding its very foundations. The lack of consensus regarding the theoretical grounds of psychiatry as a discipline has its epicenter in the discussion about the Diagnostic and Statistical Manual (DSM). A growing number of academics considers the manual broken and a growing number of patients voice concern. Despite the huge body of critique, 90% of Randomized Trials are based on DSM definitions of mental disorder. Therefore, the question regarding the ontology of mental disorder remains: what is a mental disorder, exactly? Aims We aim to identify ontologies that live among patients and clinicians, evaluate the degree of consistency and coherence between clinician and patient views and contribute to the establishment of a novel ontological paradigm of mental disorder that is aligned with patients' and clinicians' perspectives. Method Eighty participants (clinicians/patients/clinicians with lived experience) were interviewed using a semi-structured interview, exploring their ideas on the ontology of mental disorder. This question was approached from different angles which led to comprising the interview schedule into different topics: "concept of disorder," "representation by DSM," "what is treated," "what is recovered," and "the right outcome measure." Interviews were transcribed and analyzed using inductive Thematic Analysis. Results From all subthemes and main themes, a typology was constructed in which six, not necessarily mutually exclusive, ontological domains were identified: mental disorder as (1) disease, (2) functional impairment, (3) loss of adaptation, (4) existential problem, (5) highly subjective phenomenon, and (6) deviation from social norms. Common ground for the sample groups was that mental disorder is about functional impairment. Although about a fourth of sample clinicians holds an ontological concept of disease, only a small percentage of patients and none of the clinicians with lived experience adhered to an ontological concept of disease. The sample clinicians most often understand mental disorder to be a highly subjective phenomenon, and individuals with lived experience (patients and clinicians) most often understand mental (dis)order to be adaptational in nature: an (im)balance of burden in relation to strengths, skills, and recourses. Conclusion The ontological palette is more diverse than what is taught about mental disorder in dominant scientific and educational discourse. There is a need to diversify the current, dominant ontology and make room for other ontologies. Investment is required in the development, elaboration and coming of age of these alternative ontologies, allowing them to reach their full potential and act as drivers of a landscape of promising novel scientific and clinical approaches.
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Affiliation(s)
- Annemarie Catharina Johanna Kohne
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- GGZ Noord-Holland-Noord, Alkmaar, Netherlands
- Department of Psychiatry, Academic Medical Centre in Amsterdam, Amsterdam, Netherlands
| | | | | | - Jim Van Os
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
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Corentin C, Fitzgerald C, Goodwin J. Benefits of Hearing Voices Groups & Other Self-Help Groups for Voice Hearers: A Systematic Review. Issues Ment Health Nurs 2023; 44:228-244. [PMID: 37075309 DOI: 10.1080/01612840.2023.2189953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
People who hear voices that others do not often rely on mainstream mental health services. Several alternatives to treatment have grown in popularity including "Hearing Voices Groups" and other self-help groups for voice hearers. The aim of this systematic review is to evaluate the current evidence relating to the use of Hearing Voices Groups (HVGs) and other self-help groups for voice hearers, and identify the benefits felt by those attending such groups. The following databases were searched for relevant academic articles: CINAHL; APA PsycArticles; APA PsycInfo; Social Sciences; SocINDEX; UK & Ireland Reference Centre and Medline, with 13 papers identified for inclusion. Participants reported several benefits of attending a HVG/self-help group, which reduced isolation, improved social and coping skills, and gave them a better understanding of the meaning and context of their voices. The groups also provide hope for the future and act as a catalyst for recovery. These study findings suggest that voice hearers find some benefits from attending HVGs/self-help groups. Evidence indicates that voice hearers can live meaningful lives and continue to hear voices once context and meaning to their voices become clear. HVGs/self-help groups provide a vital service to voice hearers, which they felt was not available within mainstream mental health services. If mental health providers gained a better understanding of the HVN, they may be able to integrate the values and ethos of the HVN into groups for voice hearers within mainstream mental health services or signpost voice hearers to these groups.
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Cao X, Ge R, Li X, Xue M. Factors influencing self-management among patients diagnosed with anxiety disorders in China: A cross-sectional study. J Psychiatr Ment Health Nurs 2023; 30:234-244. [PMID: 35815835 DOI: 10.1111/jpm.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/13/2022] [Accepted: 07/06/2022] [Indexed: 02/05/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Self-management comprises five core skills: "Problem Solving, Decision-Making, Resource Utilization, Forming a Patient/Healthcare Provider Partnership and Taking Action." Effective self-management among patients diagnosed with anxiety can reduce the number of relapses and improve treatment outcomes. Knowledge of the impact of the family atmosphere, well-being and illness symptoms on self-management in patients diagnosed with anxiety disorders is limited. WHAT DOES THE PAPER ADD TO THE EXISTING KNOWLEDGE?: This is the first study in China to explore whether family atmosphere and well-being of patients diagnosed with anxiety disorders affects self-management. This paper adds to the list of factors influencing self-management among patients diagnosed with anxiety disorders. SAS scores are a major factor influencing self-management among patients diagnosed with anxiety disorders. The subjective well-being of patients diagnosed with anxiety disorders can influence their self-management behaviour. Patients who experienced family harmony had significantly higher self-management scores than those who experienced family disharmony. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should encourage patients diagnosed with anxiety disorders to manage their condition while receiving treatment at home. Nurses should focus on patients diagnosed with anxiety disorders who have significant anxiety symptoms and low well-being. Nurses should emphasize the importance of the home environment in family self-management and affirm that a good home environment promotes patient self-management. ABSTRACT INTRODUCTION: Better self-management can improve treatment outcomes and reduce the number of relapses for patients diagnosed with anxiety disorders. However, the impact of well-being and the home environment on self-management among patients diagnosed with anxiety disorders is unclear in China. AIM This study sought to determine the impact of the home environment, well-being and illness symptoms on self-management during home treatment for patients diagnosed with anxiety disorders. METHOD This cross-sectional study was conducted with patients diagnosed with anxiety disorders. Data were collected with SAS, Self-Management Scale for People with Anxiety Disorders and Index of Well-being. Frequency, percentage, analysis of variance, Kruskal-Wallis and multiple linear regression analyses were used. RESULTS Home environment (p < .001), self-perceived quality of life (p = .015), well-being index (p = .002) and SAS total score (p = .033) had a major impact on self-management in patients diagnosed with anxiety disorders (n = 245). DISCUSSION Family disharmony, poor self-perceived quality of life, high SAS scores and low levels of well-being were significant influences on self-management among people diagnosed with anxiety disorders. IMPLICATIONS FOR PRACTICE Nurses should focus on the self-management of patients diagnosed with significant anxiety symptoms and low well-being and value the importance of the home environment in facilitating self-management among patients diagnosed with anxiety disorders.
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Affiliation(s)
- Xinyu Cao
- West China School of Nursing, Department of Respiratory and Critical Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ruyu Ge
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolin Li
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Miao Xue
- West China School of Nursing, Department of Respiratory and Critical Medicine, West China Hospital, Sichuan University, Chengdu, China
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van Os J, Pries LK, ten Have M, de Graaf R, van Dorsselaer S, Bak M, Kenis G, Lin BD, Gunther N, Luykx JJ, Rutten BPF, Guloksuz S. Context v. algorithm: evidence that a transdiagnostic framework of contextual clinical characterization is of more clinical value than categorical diagnosis. Psychol Med 2023; 53:1825-1833. [PMID: 37310330 PMCID: PMC10106290 DOI: 10.1017/s0033291721003445] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND A transdiagnostic and contextual framework of 'clinical characterization', combining clinical, psychopathological, sociodemographic, etiological, and other personal contextual data, may add clinical value over and above categorical algorithm-based diagnosis. METHODS Prediction of need for care and health care outcomes was examined prospectively as a function of the contextual clinical characterization diagnostic framework in a prospective general population cohort (n = 6646 at baseline), interviewed four times between 2007 and 2018 (NEMESIS-2). Measures of need, service use, and use of medication were predicted as a function of any of 13 DSM-IV diagnoses, both separately and in combination with clinical characterization across multiple domains: social circumstances/demographics, symptom dimensions, physical health, clinical/etiological factors, staging, and polygenic risk scores (PRS). Effect sizes were expressed as population attributable fractions. RESULTS Any prediction of DSM-diagnosis in relation to need and outcome in separate models was entirely reducible to components of contextual clinical characterization in joint models, particularly the component of transdiagnostic symptom dimensions (a simple score of the number of anxiety, depression, mania, and psychosis symptoms) and staging (subthreshold, incidence, persistence), and to a lesser degree clinical factors (early adversity, family history, suicidality, slowness at interview, neuroticism, and extraversion), and sociodemographic factors. Clinical characterization components in combination predicted more than any component in isolation. PRS did not meaningfully contribute to any clinical characterization model. CONCLUSION A transdiagnostic framework of contextual clinical characterization is of more value to patients than a categorical system of algorithmic ordering of psychopathology.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lotta-Katrin Pries
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Margreet ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- FACT, Mondriaan Mental Health, Maastricht, The Netherlands
| | - Gunter Kenis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bochao D. Lin
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicole Gunther
- School of Psychology, Open University, Heerlen, The Netherlands
| | - Jurjen J. Luykx
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- GGNet Mental Health, Apeldoorn, The Netherlands
| | - Bart P. F. Rutten
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Ratheesh A, Hammond D, Gao C, Marwaha S, Thompson A, Hartmann J, Davey C, Zammit S, Berk M, McGorry P, Nelson B. Empirically driven transdiagnostic stages in the development of mood, anxiety and psychotic symptoms in a cohort of youth followed from birth. Transl Psychiatry 2023; 13:103. [PMID: 36990979 PMCID: PMC10052262 DOI: 10.1038/s41398-023-02396-4] [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: 08/30/2022] [Revised: 02/24/2023] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
Staging models with transdiagnostic validity across mood, psychotic, and anxiety disorders could advance early intervention efforts as well as our understanding of the common underpinnings of such psychopathology. However, there are few well-supported operationalisations for such transdiagnostic models, particularly in community-based samples. We aimed to explore the inter-relationships among mood, psychotic, and anxiety symptom stages, and their common risk factors to develop data-informed transdiagnostic stages. We included participants from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective ongoing birth cohort study. We developed operational thresholds for stages of depressive, hypomanic, anxiety, and psychotic symptoms based on the existing literature, refined further by expert consensus. We selected 1b level as the primary stage or outcome of interest. This represents moderate symptoms that are likely to be associated with the onset of the need for clinical mental health care. We used questionnaire and clinic data completed by young people ages 18 and 21 years. We used descriptive methods and network analyses to examine the overlap among Stage 1b psychopathology. We then examined the patterns of relationships between several risk factors and 1b stages using logistic regressions. Among 3269 young people with data available to determine all symptom stages, 64.3% were female and 96% Caucasian. Descriptive and network analyses indicated that 1b level depressive, anxiety, and psychotic symptom stages were inter-related while hypomania was not. Similarly, anxiety, depressive, and psychotic 1b stages were associated with the female sex, more emotional and behavioral difficulties in early adolescence, and life events in late adolescence. Hypomania was not related to any of these risk factors. Given their inter-relationships and similar risk factors, anxiety, psychotic and depressive, symptoms could be combined to form a transdiagnostic stage in this cohort. Such empirical transdiagnostic stages could help with prognostication and indicated prevention in youth mental health.
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Affiliation(s)
- Aswin Ratheesh
- Orygen, Parkville, Australia.
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | - Dylan Hammond
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Caroline Gao
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Andrew Thompson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Division of Mental Health and Wellbeing, Warwick Medical school, University of Warwick, Coventry, England
| | - Jessica Hartmann
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Christopher Davey
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Stanley Zammit
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael Berk
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Barwon Health, Geelong, Australia
| | - Patrick McGorry
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Cai RY, Gibbs V, Love A, Robinson A, Fung L, Brown L. "Self-compassion changed my life": The self-compassion experiences of autistic and non-autistic adults and its relationship with mental health and psychological wellbeing. J Autism Dev Disord 2023; 53:1066-1081. [PMID: 35904649 DOI: 10.1007/s10803-022-05668-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/24/2022]
Abstract
Self-compassion is a gentle way of relating to oneself, linked to a host of mental health benefits in non-autistic people. Although many autistic individuals report high anxiety and depression symptoms, no research to-date has examined the self-compassion experiences of autistic individuals and determined if self-compassion is associated with psychopathology. Therefore, the purpose of the current study was to address this research gap. The participants (153 autistic and 93 non-autistic adults) completed on online survey and 11 autistic participants were also interviewed. Autistic participants reported significantly lower self-compassion than non-autistic adults, and in both groups, those with higher self-compassion reported higher psychological wellbeing and lower depression symptoms. Demographic predictors of self-compassion were identified. These findings have both clinical and research implications.
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Affiliation(s)
- Ru Ying Cai
- Aspect Research Centre for Autism Practice, Autism Spectrum Australia, 14 Aquatic Drive, 2086, Frenchs Forest, NSW, Australia.
- School of Psychological Sciences, Monash University, 3168, Clayton, VIC, Australia.
| | - Vicki Gibbs
- Aspect Research Centre for Autism Practice, Autism Spectrum Australia, 14 Aquatic Drive, 2086, Frenchs Forest, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, 2050, Camperdown, NSW, Australia
| | - Abigail Love
- Aspect Research Centre for Autism Practice, Autism Spectrum Australia, 14 Aquatic Drive, 2086, Frenchs Forest, NSW, Australia
| | - Ainslie Robinson
- Aspect Research Centre for Autism Practice, Autism Spectrum Australia, 14 Aquatic Drive, 2086, Frenchs Forest, NSW, Australia
| | - Lawrence Fung
- Department of Psychiatry & Behavioral Sciences, Stanford University, 94305, Stanford, CA, USA
| | - Lydia Brown
- Melbourne School of Psychological Sciences, University of Melbourne, 2010, Parkville, VIC, Australia
- North Eastern Rehabilitation Centre, Healthscope Hospitals, 3079, Ivanhoe, VIC, Australia
- Office of the Provost, School of Science, Health and Engineering, La Trobe University, 3083, Bundoora, VIC, Australia
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31
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Elhilali L, Burr C, Rabenschlag F, Zuaboni G, Eissler C, Richter D. Psychometric assessment of the German version of the Questionnaire about the Process of Recovery. Int J Ment Health Nurs 2023; 32:314-322. [PMID: 36330563 DOI: 10.1111/inm.13083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
Personal recovery is important for mental health services and service users; moreover, valid and reliable assessment instruments are necessary for measuring personal recovery. Therefore, this study aimed to evaluate the unidimensional factor structure of the German version of the Questionnaire about the Process of Recovery. The study was conducted using a cross-sectional design with a convenience sample. The questionnaire was completed by 200 patients of outpatient services of two psychiatric hospitals in Switzerland. A confirmatory factor analysis was conducted to validate the unidimensional factor structure of the German version of the Questionnaire about the Process of Recovery. Cronbach's alpha was calculated to assess the internal consistency. The results showed an overall acceptable model fit (χ2 = 134.188, df = 90, P = 0.002; RMSEA = 0.050, 90% CI: 0.031-0.067; CFI = 0.937; TLI = 0.927) and excellent internal consistency (Cronbach's α = 0.91). These results are consistent with those of studies that have examined the Questionnaire about the Process of Recovery in other languages. This study provides preliminary evidence that the German version of the Questionnaire about the Process of Recovery is a reliable assessment instrument for measuring personal recovery among people with mental illness experiences. However, it is necessary to conduct further psychometric tests to verify the validity and reliability of the instrument. The German version of the Questionnaire about the Process of Recovery can be applied to both research and clinical practice, especially as a means of facilitating communication during the planning and evaluation of treatment goals.
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Affiliation(s)
- Laila Elhilali
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, Bern University Hospital for Mental Health, Bern, Switzerland
| | - Christian Burr
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, Bern University Hospital for Mental Health, Bern, Switzerland
| | | | - Gianfranco Zuaboni
- University Hospital of Psychiatry and Psychotherapy, Bern University Hospital for Mental Health, Bern, Switzerland.,Psychiatric and Psychotherapy Hospital, Sanatorium Kilchberg AG, Kilchberg, Switzerland
| | - Christian Eissler
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Dirk Richter
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, Bern University Hospital for Mental Health, Bern, Switzerland.,Centre for Psychiatric Rehabilitation, Bern University Hospital for Mental Health, Bern, Switzerland
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Predictors of functional impairment at assessment and functional improvement after treatment at a national digital mental health service. Internet Interv 2023; 31:100603. [PMID: 36756355 PMCID: PMC9900502 DOI: 10.1016/j.invent.2023.100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/30/2022] [Accepted: 01/20/2023] [Indexed: 01/23/2023] Open
Abstract
Mental disorders are associated with impairment to daily functioning, which affects both the individual and society. Despite this, most research on treatment outcome only report symptom change. Self-reported days out of role (DOR) is a simple measure of functional impairment used in many population studies. The current study sought to report on the degree of functional impairment measured by DOR in a clinical sample at assessment, the factors associated with this impairment, the predictors of functional improvement after treatment and the relationship between symptomatic and functional change. Using a prospective uncontrolled observational cohort study design with a sample of 17,813 patients accessing a digital mental health service (DMHS), we examined self-reported demographic, psychosocial and clinical data. Using a series of univariate regression models and multivariate classification algorithms, we found that baseline DOR was associated with age, employment and relationship status, symptom severity, symptom chronicity and with the presence of several psychosocial difficulties. Baseline DOR was best predicted by older age, disability payments, higher symptom severity and increasing number of endorsed psychosocial difficulties (R2 = 32.7 %). Forty-one per cent of the sample experienced a >50 % or greater reduction in DOR following treatment. Those who were separated, unemployed or on disability payments, or with severe and chronic depression, experienced the greatest reductions in DOR after treatment. Changes in functioning were independent of changes in symptoms, highlighting the importance of functional impairment as a treatment outcome. This study found that many of the patients who access DMHS have significant levels of functional impairment, a large proportion obtain functional improvement after treatment, and improvement in function after treatment was independent of improvement in symptoms.
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Lorenz-Artz K, Bierbooms J, Bongers I. Introducing Peer-supported Open Dialogue in changing mental health care. Front Psychol 2023; 13:1056071. [PMID: 36743614 PMCID: PMC9891459 DOI: 10.3389/fpsyg.2022.1056071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023] Open
Abstract
The need to transform mental health care toward person-centered, recovery-based, and network-oriented care is recognized worldwide. Open Dialogue (OD) is seen as a hopeful approach in the context of this transformation and is introduced in countries around the globe. Five Dutch mental health care organizations spread over the Netherlands introduced the Peer-supported Open Dialogue (POD) approach, which adds an explicit role of peer-support workers to the OD approach. It appeared that (P)OD-trained professionals face issues in introducing the (P)OD approach in existing MHC settings. One of the reasons, which is the focus of this study, may be that they encounter difficulties in explaining to non-(P)OD-trained professionals what (P)OD entails. The main objective of this study is to provide guidance to and contribute to making (P)OD better understandable for non-(P)OD-trained professionals. In this study, we used a qualitative design and conducted 23 semi-structured interviews with POD-trained professionals with various backgrounds, to cultivate a rich understanding of which aspects could contribute to a better understanding of POD for non-POD-trained professionals. We used a hybrid approach to analyze the data, meaning that the technique of both inductive and deductive thematic analyses has been applied. From these analyses, six aspects emerged that could give guidance to and contribute to making (P)OD more understandable for non-(P)OD-trained professionals: (1) Experiencing (P)OD by attending treatment network sessions, (2) a coherent and profound narrative about (P)OD, (3) adjusting terminology to better fit the context, such as the two terms "principles" and "responsibility" in this study, (4) the order in which (P)OD elements are introduced in the narrative, (5) bringing the elements "presence," "reflecting," and "expertise by experience" more to the foreground, and (6) conceptualizing the main elements in a "talking paper." A better understanding of (P)OD might be one of the building blocks for improving (P)OD adoption in existing MHC practices, which are on their way toward person-centered, recovery-based, and network-oriented care.
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Affiliation(s)
- Karin Lorenz-Artz
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands,Mental Health Care Institute, Eindhoven, Netherlands,*Correspondence: Karin Lorenz-Artz, ✉
| | - Joyce Bierbooms
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands,Erasmus School of Health Policy and Management (ESHPM), Erasmus University, Rotterdam, Netherlands
| | - Inge Bongers
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands,Mental Health Care Institute, Eindhoven, Netherlands
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King I, Shapiro Y. Learning the "Science of the Art of Prescribing": From Evidence-based Algorithms to Individualized Medicine in Psychiatric Care. J Psychiatr Pract 2022; 28:409-420. [PMID: 36074111 DOI: 10.1097/pra.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this review is to highlight the limitations of the traditional diagnosis/evidence-based symptom reduction paradigm and advocate for an individualized medicine approach that incorporates psychological and relational aspects of prescribing in addition to the objective patient presentation. Potential barriers, challenges, and proposed future directions for improving education in psychological and relational aspects of prescribing are discussed. Psychological aspects of prescribing, as recently spelled out in the field of psychodynamic psychopharmacology, are generally acknowledged as important, but they do not have a well-defined position in contemporary residency training throughout North America. While residents receive in-depth exposure to diverse aspects of what to prescribe in their psychopharmacological training, and they work with patients' subjective and relational meaning and the quality of the therapeutic alliance in their psychotherapy rotations, an integrated approach to how to prescribe is generally lacking. Despite many legitimate challenges, the authors suggest that teaching an integrated approach that incorporates objective, subjective, and relational factors in the provision of psychopharmacology and utilizing evidence-based principles of individualized care should be prioritized in both residency training and the provision of psychiatric treatment as a whole.
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Affiliation(s)
- Ian King
- KING and SHAPIRO: Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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35
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Gao T, Mei S, Li M, Arcy CD, Meng X. Roles of Psychological Distress and Social Support in the Relationship Between Childhood Maltreatment and Perceived Needs for Mental Health Care. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP14089-NP14116. [PMID: 33858262 DOI: 10.1177/08862605211006368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Childhood maltreatment is a major public health issue worldwide. It increases a range of health-risk behaviors, psychological and physical problems, which are associated with an increased need for mental health services in adulthood. Identification of mediating factors in the relationship between maltreatment and seeking mental health care may help attenuate the negative consequences of childhood maltreatment and promote more appropriate treatment. This study aims to examine whether the relationship between childhood maltreatment and perceived need for mental health care is mediated by psychological distress and/or moderated by social support. Data from the Canadian Community Health Survey-Mental Health 2012 are analyzed. A total of 8,993 participants, who had complete information on childhood maltreatment and diagnoses of mental disorders or psychological distress, are included in this study. Structural equation modeling and the PROCESS macro were used to identify relationships among childhood maltreatment, perceived needs for mental health care, and psychological distress. Hierarchical linear regression was then used to verify the moderated mediation model. We found that psychological distress partially mediated the effect of childhood maltreatment on perceived needs for mental health care in adulthood. Social support played an important role in terms of moderating the relationship between maltreatment and perceived needs for care. For those with a history of childhood maltreatment, those who perceived a low level of social support were more likely to have higher levels of psychological distress and perceived need for mental health care. This is the first study to identify the separate and combined roles of psychological distress and social support in the relationship between childhood maltreatment and perceived need for mental health care. Selective prevention strategies should focus on social support to improve mental health services among people with a history of childhood maltreatment.
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Affiliation(s)
- Tingting Gao
- Jilin University, Changchun, China
- McGill University, Montreal, Canada
- Douglas Mental Health University Institute, Montreal, Canada
- Shandong University, Jinan, China
| | | | - Muzi Li
- McGill University, Montreal, Canada
- Douglas Mental Health University Institute, Montreal, Canada
| | | | - Xiangfei Meng
- McGill University, Montreal, Canada
- Douglas Mental Health University Institute, Montreal, Canada
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Henquet C, van Os J, Pries LK, Rauschenberg C, Delespaul P, Kenis G, Luykx JJ, Lin BD, Richards AL, Akdede B, Binbay T, Altınyazar V, Yalınçetin B, Gümüş-Akay G, Cihan B, Soygür H, Ulaş H, Cankurtaran ES, Kaymak SU, Mihaljevic MM, Petrovic SS, Mirjanic T, Bernardo M, Mezquida G, Amoretti S, Bobes J, Saiz PA, García-Portilla MP, Sanjuan J, Aguilar EJ, Santos JL, Jiménez-López E, Arrojo M, Carracedo A, López G, González-Peñas J, Parellada M, Maric NP, Atbaşoğlu C, Ucok A, Alptekin K, Saka MC, Arango C, O'Donovan M, Rutten BP, Gülöksüz S. A replication study of JTC bias, genetic liability for psychosis and delusional ideation. Psychol Med 2022; 52:1777-1783. [PMID: 33046166 PMCID: PMC9280279 DOI: 10.1017/s0033291720003578] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study attempted to replicate whether a bias in probabilistic reasoning, or 'jumping to conclusions'(JTC) bias is associated with being a sibling of a patient with schizophrenia spectrum disorder; and if so, whether this association is contingent on subthreshold delusional ideation. METHODS Data were derived from the EUGEI project, a 25-centre, 15-country effort to study psychosis spectrum disorder. The current analyses included 1261 patients with schizophrenia spectrum disorder, 1282 siblings of patients and 1525 healthy comparison subjects, recruited in Spain (five centres), Turkey (three centres) and Serbia (one centre). The beads task was used to assess JTC bias. Lifetime experience of delusional ideation and hallucinatory experiences was assessed using the Community Assessment of Psychic Experiences. General cognitive abilities were taken into account in the analyses. RESULTS JTC bias was positively associated not only with patient status but also with sibling status [adjusted relative risk (aRR) ratio : 4.23 CI 95% 3.46-5.17 for siblings and aRR: 5.07 CI 95% 4.13-6.23 for patients]. The association between JTC bias and sibling status was stronger in those with higher levels of delusional ideation (aRR interaction in siblings: 3.77 CI 95% 1.67-8.51, and in patients: 2.15 CI 95% 0.94-4.92). The association between JTC bias and sibling status was not stronger in those with higher levels of hallucinatory experiences. CONCLUSIONS These findings replicate earlier findings that JTC bias is associated with familial liability for psychosis and that this is contingent on the degree of delusional ideation but not hallucinations.
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Affiliation(s)
- Cécile Henquet
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
| | - Lotta K. Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Christian Rauschenberg
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Gunter Kenis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jurjen J. Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- GGNet Mental Health, Apeldoorn, The Netherlands
| | - Bochao D. Lin
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexander L. Richards
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Berna Akdede
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Tolga Binbay
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Vesile Altınyazar
- Department of Psychiatry, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Berna Yalınçetin
- Department of Neuroscience, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - Güvem Gümüş-Akay
- Department of Physiology, School of Medicine, Ankara University, Ankara, Turkey
- Brain Research Center, Ankara University, Ankara, Turkey
| | - Burçin Cihan
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Haldun Soygür
- Turkish Federation of Schizophrenia Associations, Ankara, Turkey
| | - Halis Ulaş
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey (Discharged by statutory degree No: 701 at 8th July of 2018, because of signing “Peace Petition”)
| | | | - Semra U. Kaymak
- Atatürk Research and Training Hospital Psychiatry Clinic, Ankara, Turkey
| | - Marina M. Mihaljevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Psychiatry CCS, Belgrade, Serbia
| | | | - Tijana Mirjanic
- Special Hospital for Psychiatric Disorders Kovin, Kovin, Serbia
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Julio Bobes
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain
- Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Pilar A. Saiz
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain
- Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Maria P. García-Portilla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain
- Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Julio Sanjuan
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Eduardo J. Aguilar
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Jose L. Santos
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, Hospital Virgen de la Luz, Cuenca, Spain
| | - Estela Jiménez-López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Instituto de Investigación Sanitaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Carracedo
- Grupo de Medicina Genómica, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Universidad de Santiago de Compostela, Santiago de Compostela, Spain
- Fundación Publica Galega de Medicina Xenómica (SERGAS), IDIS, Santiago de Compostela, Spain
| | - Gonzalo López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier González-Peñas
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mara Parellada
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Nadja P. Maric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Mental Health, Belgrade, Serbia
| | - Cem Atbaşoğlu
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Alp Ucok
- Department of Psychiatry, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- Department of Neuroscience, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - Meram C. Saka
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Celso Arango
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Michael O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Bart P.F. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Sinan Gülöksüz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Bergström T, Seikkula J, Holma J, Köngäs-Saviaro P, Taskila JJ, Alakare B. Retrospective Experiences of First-Episode Psychosis Treatment Under Open Dialogue-Based Services: A Qualitative Study. Community Ment Health J 2022; 58:887-894. [PMID: 34550512 PMCID: PMC9187564 DOI: 10.1007/s10597-021-00895-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023]
Abstract
Open Dialogue (OD) is an integrated approach to mental health care, which has demonstrated promising outcomes in the treatment of first-episode psychosis (FEP) in Finnish Western Lapland region. However, little is known how treatment under OD is retrospectively experienced by the service users themselves. To address this, twenty participants from the original Western Lapland research cohort diagnosed with psychosis (F20-F29) were asked about their treatment of FEP, initiated under OD 10-23 years previously. Thematic analysis was used to explore how the treatment was experienced. Most participants viewed network treatment meetings as an important part of their treatment, as they enabled interactions with other people and the chance to go through difficult experiences. A minority of the participants had mixed experiences regarding family involvement and immediate home visits. OD may have the potential to promote therapeutic relationships, but replications from other catchment areas are needed.
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Affiliation(s)
- Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland.
- Department of Psychiatry, Länsi-Pohja Hospital District, Kemi, Finland.
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
| | - Juha Holma
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
| | | | - Jyri J Taskila
- Department of Psychiatry, Länsi-Pohja Hospital District, Kemi, Finland
| | - Birgitta Alakare
- Department of Psychiatry, Länsi-Pohja Hospital District, Kemi, Finland
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Hauber K, Boon A. First-Session Therapeutic Relationship and Outcome in High Risk Adolescents Intensive Group Psychotherapeutic Programme. Front Psychol 2022; 13:916888. [PMID: 35783793 PMCID: PMC9245890 DOI: 10.3389/fpsyg.2022.916888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAn important determinant of therapy outcome is the quality of the therapeutic relationship. This study evaluated the association between the client’s assessment of first-session therapeutic relationship (FSTR) and outcome in an intensive treatment for adolescents with personality disorders.MethodPatients (N = 92) were measured weekly during intensive group treatment. The therapeutic relationship was measured with the Child version of the Session Rating Scale (C-SRS) that was completed after each group therapy session by the patient. Outcome was measured with the Child version of the Outcome Rating Scale (C-ORS). Reliable change index (RCI) was calculated for the both instruments to determine significant changes in therapeutic relationship and outcome.ResultsA good FRST gave twice as much chance of a significantly better outcome. Especially for those with moderate FSTR, establishing and maintaining a good working relationship during treatment could increase the chances of a good outcome considerably. In contrast, adolescents with low FSTR had little chance of positive outcome regardless of any improvement in the therapeutic relationship.ConclusionAdolescents assessment of FRST is indicative of the chance of a good outcome.
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Affiliation(s)
- Kirsten Hauber
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Centre, Leiden, Netherlands
- Parnassia Psychiatric Institute, Youz Child and Adolescent Psychiatry, The Hague, Netherlands
- *Correspondence: Kirsten Hauber,
| | - Albert Boon
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Centre, Leiden, Netherlands
- Parnassia Psychiatric Institute, Youz Child and Adolescent Psychiatry, The Hague, Netherlands
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Rottenberg J, Kashdan TB. Well-Being After Psychopathology: A Transformational Research Agenda. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2022. [DOI: 10.1177/09637214221093616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
If one struggles with depression, anxiety, or suicidal impulses, what is the best outcome that one can hope for? Can psychopathology be a bridge to a better place where people operate with autonomy and self-mastery, enjoy healthy relationships, experience frequent positive emotions, and view life as meaningful and purposeful? Studies of national samples have revealed that a substantial number of people with depression, panic disorder, and suicidal impulses go on to achieve high levels of psychological well-being. We consider the practical and theoretical implications of these findings and call for a transformational mental-health agenda that focuses on good outcomes.
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Formica MJC, Phillips LJ, Hartmann JA, Yung AR, Wood SJ, Lin A, Amminger GP, McGorry PD, Nelson B. Has improved treatment contributed to the declining rate of transition to psychosis in ultra-high-risk cohorts? Schizophr Res 2022; 243:276-284. [PMID: 32402606 DOI: 10.1016/j.schres.2020.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 03/11/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The factors contributing to declining psychotic disorder transition rates in ultra-high-risk populations remain unclear. We examined the contribution of longitudinal changes in standard clinical treatment ('treatment as usual') to this decline. METHOD An audit was conducted on 105 clinical files of patients who received standard care at a specialised ultra-high-risk service. The session notes of these files were quantified, allowing examination of treatment quantity, targets, psychotherapy, and medication. Differences in these aspects across patients' year of clinic entry were assessed. Variables with significant differences across years were examined using cox regression to assess their contribution to psychosis transition rates. RESULTS Findings were that, as a function of patients' year of clinic entry, there were increases in: patients' number of sessions, cognitive behavioural therapy (CBT), problem and solving therapy. There was a relationship between baseline year cohort and psychosis transition rate, with lower rates observed in more recent cohorts. When changes in treatment between cohorts were adjusted for, the relationship between baseline year cohort and transition rate disappeared. The relationship between baseline year and transition rate was attenuated most by increases in CBT. CONCLUSION Changes in standard treatment, particularly increases in CBT, may have contributed to the decline in psychosis risk observed in recent ultra-high-risk cohorts, although these variables do not fully explain this trend. Implications for clinical practice, prediction and intervention research are discussed. Future ultra-high-risk research should investigate the impact of other treatment factors, such as therapeutic alliance.
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Affiliation(s)
- M J C Formica
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
| | - L J Phillips
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - J A Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - A R Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - S J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; School of Psychology, University of Birmingham, United Kingdom
| | - A Lin
- Telethon Kids Institute, The University of Western Australia, Australia
| | - G P Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - P D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - B Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
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Shah JL, Jones N, van Os J, McGorry PD, Gülöksüz S. Early intervention service systems for youth mental health: integrating pluripotentiality, clinical staging, and transdiagnostic lessons from early psychosis. Lancet Psychiatry 2022; 9:413-422. [PMID: 35430004 DOI: 10.1016/s2215-0366(21)00467-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/29/2021] [Accepted: 11/16/2021] [Indexed: 12/21/2022]
Abstract
Challenges associated with operationalising services for the at-risk mental state for psychosis solely in that same diagnostic silo are increasingly well recognised-namely, the differential risk for psychosis being a function of sampling enrichment strategies, declining transition rates to psychosis, questions regarding the validity of transition as an outcome, and the frequent development of non-psychotic disorders. However, recent epidemiological and clinical research suggests that not all threshold-level psychoses are likely to occur homotypically; early-stage non-psychotic syndromes might exhibit heterotypic shifts to a first episode of psychosis, without an identifiable at-risk mental state. These findings, along with the relevance of outcomes beyond traditional diagnoses or syndromes, have substantive implications for developing next-generation early intervention infrastructures. Along with the idea of general at-risk clinics for early-stage pluripotential syndromes, we examine how this reality might affect service design, such as the need for close linkage with centres of expertise for threshold-level disorders when transitions to later stages occur, the balance between generic and specific interventions amid the need for person-centred care, and the challenges this reorientation might pose for broader mental health systems.
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Affiliation(s)
- Jai L Shah
- Prevention and Early Intervention Program for Psychosis (PEPP)-Montreal, Montreal, QC, Canada; ACCESS Open Minds, Douglas Hospital Research Centre, Montreal, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sinan Gülöksüz
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Amendola S, Hengartner MP, Ajdacic-Gross V, Angst J, Rössler W. Longitudinal reciprocal associations between depression, anxiety, and substance use disorders over three decades of life. J Affect Disord 2022; 302:315-323. [PMID: 35093414 DOI: 10.1016/j.jad.2022.01.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Studies exploring longitudinal reciprocal associations between depressive, anxiety, and substance use disorders (DD, AD and SUD, respectively) over long periods of time are mainly lacking. Therefore, the aim of the present study is to test longitudinal associations (i.e. temporal dynamics) between DD, AD and SUD from young adulthood to middle adulthood. METHODS A stratified community sample of 591 participants from the canton of Zurich, Switzerland, was interviewed with the Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology over seven interview waves from ages 20/21 to 49/50. Diagnostic and Statistical Manual of Mental Disorders criteria were used to evaluate the presence of DD, AD and SUD. We fitted an auto-regressive cross-lagged path analysis within a Bayesian structural equation model to test longitudinal associations. RESULTS Regarding autoregressive effects, AD (except during young adulthood) and SUD predicted themselves over the entire time period, while DD recurrently predicted itself not consistently over time. Regarding cross-lagged effects, DD predicted SUD at different time points, and vice versa. DD predicted subsequent AD in adulthood, whereas the reverse did not happen. Female gender was associated with DD and AD at all ages while male gender was associated with SUD only in young adulthood. CONCLUSIONS Reciprocal longitudinal associations were found between DD and SUD and DD usually preceded AD. Our results further confirm an increased risk of DD and AD in women and a higher risk of SUD in young men. Early treatment and broad psychosocial interventions should be provided in order to prevent chronicity and further maladjustment as well as interrupting the cycle of mutual reinforcement between DD and SUD.
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Affiliation(s)
- Simone Amendola
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza - University of Rome, Rome, Italy.
| | | | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany
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Schizophrenia as a symptom of psychiatry's reluctance to enter the moral era of medicine. Schizophr Res 2022; 242:138-140. [PMID: 34991949 DOI: 10.1016/j.schres.2021.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/11/2021] [Accepted: 12/12/2021] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE The biopsychosocial (BPS) model remains the predominant theoretical framework underpinning contemporary psychiatric training and practice. Like all models, it has its limitations and its critics. In light of recent censure, The purpose of this article was to (a) review key aspects of the history, development and contemporary utility of the BPS model and, (b) review key contributions of George Engel. CONCLUSION An aetiological model for mental disorders that involves psychological, biological and sociocultural factors has existed since at least the 1940s. The term "biopsychosocial" was arguably first coined by Roy Grinker in 1952. Spurred on by his interest in systems theory, Engel expanded upon the model in 1977 and used it to hypothesise about the integration of mind and body. Despite its shortcomings, the BPS model remains relevant and useful.
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Affiliation(s)
- William Lugg
- Consultation-Liaison Psychiatry Advanced Trainee, Department of Consultation-Liaison Psychiatry, Royal Prince Alfred Hospital, Sydney, Australia
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45
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Psychometric properties of a brief, self-report measure of social inclusion: the F-SIM16. Epidemiol Psychiatr Sci 2022; 31:e8. [PMID: 35060845 PMCID: PMC8786614 DOI: 10.1017/s2045796021000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS A disproportionate number of people with mental ill-health experience social exclusion. Appropriate measurement tools are required to progress opportunities to improve social inclusion. We have developed a novel measure, the Filia Social Inclusion Measure (F-SIM). Here we aimed to present a more concise, easy-to-use form, while retaining its measurement integrity by (i) refining the F-SIM using traditional and contemporary item-reduction techniques; and (ii) testing the psychometric properties of the reduced measure. METHODS Five hundred and six participants completed the F-SIM, younger and older groups of people with serious mental illness (including psychosis, mood, anxiety disorders) and same-aged community counterparts. The F-SIM was completed at baseline and 2-week follow-up, alongside other measures (including social inclusion, loneliness). The F-SIM was refined using multidimensional scaling network analysis, confirmatory factor analysis and item response theory. The psychometric evaluation included assessment of dimensionality, internal consistency, test-retest reliability, discriminant ability and construct validity. RESULTS The F-SIM was reduced from 135-items to 16; with 4-items in each domain of housing and neighbourhood, finances, employment and education and social participation and relationships. Psychometric properties were sound, including strong internal consistency within domains (all α > 0.85) and excellent overall (α = 0.92). Test-retest reliability was also high (γ = 0.90). Differences between groups were observed; clinical subgroups consistently reported lower levels of social inclusion compared to community counterparts. CONCLUSIONS The F-SIM16 is a sound, reliable, brief self-report measure of social inclusion suitable for use in clinical and research settings. It has the potential to evaluate the effectiveness of interventions, and aid in fostering targeted and personalised needs-based care.
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Steen A, Graste S, Schuhmann C, de Kubber S, Braam AW. A Meaningful Life? A Qualitative Narrative Analysis of Life Stories of Patients with Personality Disorders Before and After Intensive Psychotherapy. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2022. [DOI: 10.1080/10720537.2021.2015729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Angelien Steen
- University of Humanistic Studies, Utrecht, the Netherlands
- Centre for Psychotherapy, GGz Centraal, Ermelo, the Netherlands
| | - Sanne Graste
- Centre for Psychotherapy, GGz Centraal, Ermelo, the Netherlands
| | | | - Sylvie de Kubber
- University of Humanistic Studies, Utrecht, the Netherlands
- Parnassia groep, The Hague, the Netherlands
| | - Arjan W. Braam
- University of Humanistic Studies, Utrecht, the Netherlands
- Altrecht, Utrecht, the Netherlands
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Richter D, Dixon J. Models of mental health problems: a quasi-systematic review of theoretical approaches. J Ment Health 2022; 32:396-406. [PMID: 35014924 DOI: 10.1080/09638237.2021.2022638] [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: 10/19/2022]
Abstract
BACKGROUND Mental health and mental illness have been contested concepts for decades, with a wide variety of models being proposed. To date, there has been no exhaustive review that provides an overview of existing models. AIM To conduct a quasi-systematic review of theoretical models of mental health problems. METHODS We searched academic databases, reference lists, and an electronic bookshop for literature that proposed, endorsed, reviewed, or critiqued such models. Papers, book chapters, and books were included with material by researchers, clinicians, non-medical professions, and service users writing between 2000 to June 2020 being considered. The study was registered with the Open Science Framework (No. osf.io/r3tjx). RESULTS Based on 110 publications, we identified 34 different models which were grouped into five broader categories. Many models bridged two or more categories. Biological and psychological approaches had the largest number of models while social, consumer and cultural models were less diversified. Due to the non-empirical nature of the publications, several limitations in terms of search and quality appraisal apply. CONCLUSIONS We conclude that mental health care needs to acknowledge the diversity of theoretical models on mental health problems.
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Affiliation(s)
- Dirk Richter
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Center for Psychiatric Rehabilitation, Bern University Hospital for Mental Health, Bern, Switzerland
| | - Jeremy Dixon
- Department of Social and Policy Sciences, University of Bath, Bath, UK
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Leendertse P, Hirzalla F, van den Berg D, Castelein S, Mulder CL. Facilitating and hindering factors of personal recovery in the context of Soteria-A qualitative study among people with (early episode) psychosis. Front Psychiatry 2022; 13:1051446. [PMID: 36683984 PMCID: PMC9848445 DOI: 10.3389/fpsyt.2022.1051446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The objective of this study was to gain insight into patients' experiences of how personal recovery (PR) is facilitated or hindered in the context of an early episode psychosis setting (Soteria). We thereby aimed to contribute to the understanding of how care settings may promote or hinder the process of PR in people with (acute) psychosis. METHOD This study used a qualitative method, consisting of semi-structured in-depth interviews with people who had been admitted to a Soteria house in the Netherlands. Interview transcripts were analyzed following the Grounded Theory approach. RESULTS Five themes emerged from the data illustrating how Soteria facilitated or impeded PR. The experience of togetherness in contact with staff and peers, feeling at home, and being active facilitated PR, while the emphasis put on medication by staff was experienced as hindering, and attention to spirituality was missed. CONCLUSION In addition to the literature that identified factors associated with PR in psychosis, the current study gives a sense of how this can be put into practice. By offering treatment within a normalizing, holding environment, with emphasis on equality, close contact, optimism, active structured days, open-mindedness toward spirituality, and the role of medication, PR can be facilitated without detracting from guideline-based treatment aimed at symptomatic recovery. Similarities with existing concepts are discussed.
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Affiliation(s)
- Pien Leendertse
- Emergis, Institute for Mental Healthcare, Kloetinge, Netherlands.,Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Fadi Hirzalla
- Department of Public Administration and Sociology, Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, Netherlands
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Stynke Castelein
- Lentis Research, Lentis Psychiatric Institute, Groningen, Netherlands.,Faculty of Behavioral and Social Sciences, Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Cornelis Lambert Mulder
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands.,Antes, Institute for Mental Healthcare, Parnassia Psychiatric Institute, Rotterdam, Netherlands
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49
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van Sambeek N, Baart A, Franssen G, van Geelen S, Scheepers F. Recovering Context in Psychiatry: What Contextual Analysis of Service Users' Narratives Can Teach About Recovery Support. Front Psychiatry 2021; 12:773856. [PMID: 34987427 PMCID: PMC8720875 DOI: 10.3389/fpsyt.2021.773856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Aim: Enhancement of recovery-oriented care in psychiatry requires insight into the personal meaning and context of recovery. The Psychiatry Story Bank is a narrative project, designed to meet this need, by collecting, sharing and studying the narratives of service-users in psychiatry. Our study was aimed at expanding insight into personal recovery through contextual analysis of these first-person narratives. Methods: We analyzed 25 narratives, as collected through research interviews. To capture the storied context on both a personal, interpersonal and ideological level we combined several forms of qualitative analysis. A total of 15 narrative characteristics were mapped and compared. Results: Through comparative analysis we identified four narratives genres in our sample: Lamentation (narratives about social loss), Reconstruction (narratives about the impact of psychosis), Accusation (narratives about injustice in care), and Travelogue (narratives about identity transformation). Each genre provides insight into context-bound difficulties and openings for recovery and recovery-support. Conclusion: A contextual approach to studying personal recovery offers insights that can help attune recovery support in psychiatry. Important clues for recovery support can be found in people's narrated core struggle and the associated desire to be recognized in a particular way. Our results also indicate that familiarity with different ways of understanding mental distress, can help people to express and reframe their struggles and desires in a helpful way, thereby facilitating recognition.
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Affiliation(s)
- Nienke van Sambeek
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Andries Baart
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Humanities, Optentia Research Unit Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Gaston Franssen
- Department of Dutch Literary Studies, Faculty of Humanities, University of Amsterdam, Amsterdam, Netherlands
| | | | - Floortje Scheepers
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
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50
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Glas G. Person-centred care in psychiatry: a clinical and philosophically informed approach. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2021.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
After many years of mental healthcare reform there is still a lot of unease among patients about healthcare workers’ lack of attention to their daily needs and to the tensions and ambiguities that accompany their attempts to integrate their condition into their lives. Person-centred care is often presented as a solution, but the term refers to many differing approaches and needs further specification depending on the problem it aims to resolve. This article presents and discusses a clinical and philosophically informed approach that flexibly focuses on the person- and context-bound aspects of the patient's condition and on the co-regulatory role of the clinician in the patient's attempt to regulate their condition. This approach is a way of thinking, rather than yet another model. It will be shown how this approach can be integrated in the core curriculum of specialty (residency) training in psychiatry.
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