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Schultze-Lutter F, Banaschewski T, Barth GM, Bechdolf A, Bender S, Flechtner HH, Hackler S, Heuer F, Hohmann S, Holzner L, Huss M, Koutsouleris N, Lipp M, Mandl S, Meisenzahl E, Munz M, Osman N, Peschl J, Reissner V, Renner T, Riedel A, Romanos M, Romer G, Schomerus G, Thiemann U, Uhlhaas PJ, Woopen C, Correll CU, Care-Konsortium D. [Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024. [PMID: 38809160 DOI: 10.1024/1422-4917/a000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders Abstract: As a vulnerable group, minors require special protection in studies. For this reason, researchers are often reluctant to initiate studies, and ethics committees are reluctant to authorize such studies. This often excludes minors from participating in clinical studies. This exclusion can lead to researchers and clinicians receiving only incomplete data or having to rely on adult-based findings in the treatment of minors. Using the example of the study "Computer-Assisted Risk Evaluation in the Early Detection of Psychotic Disorders" (CARE), which was conducted as an 'other clinical investigation' according to the Medical Device Regulation, we present a line of argumentation for the inclusion of minors which weighs the ethical principles of nonmaleficence (especially regarding possible stigmatization), beneficence, autonomy, and fairness. We show the necessity of including minors based on the development-specific differences in diagnostics and early intervention. Further, we present specific protective measures. This argumentation can also be transferred to other disorders with the onset in childhood and adolescence and thus help to avoid excluding minors from appropriate evidence-based care because of insufficient studies.
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Affiliation(s)
- Frauke Schultze-Lutter
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesien
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Schweiz
| | - Tobias Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - Gottfried M Barth
- Abteilung Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Deutschland
| | - Andreas Bechdolf
- Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
- Klinik für Psychiatrie und Psychotherapie, CCM, Charité - Universitätsmedizin Berlin, Deutschland
- Deutsches Zentrum für Psychische Gesundheit, Standort Berlin, Deutschland
| | - Stephan Bender
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Hans-Henning Flechtner
- Universitätsklinik für Psychiatrie, Psychotherapie und psychosomatische Medizin des Kindes- und Jugendalters, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - Sandra Hackler
- Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LVR-Klinik Bonn, Bonn, Deutschland
| | - Fabiola Heuer
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
| | - Sarah Hohmann
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikums Hamburg-Eppendorf, Hamburg, Deutschland
| | - Laura Holzner
- Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
| | - Michael Huss
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz; Mainz, Deutschland
| | - Nikolaos Koutsouleris
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
- Max Planck Institute of Psychiatry, Max Planck Fellow Group Precision Psychiatry, München, Deutschland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael Lipp
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Selina Mandl
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Universität München, Klinikum der Universität München, Deutschland
| | - Eva Meisenzahl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Manuel Munz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters des Zentrums für Integrative Psychiatrie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Deutschland
| | - Naweed Osman
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Jens Peschl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Volker Reissner
- Abteilung für Kinder- und Jugendpsychiatrie, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Deutschland
| | - Tobias Renner
- Abteilung Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Deutschland
| | - Anett Riedel
- Universitätsklinik für Psychiatrie, Psychotherapie und psychosomatische Medizin des Kindes- und Jugendalters, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - Marcel Romanos
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Deutschland
| | - Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster, Deutschland
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Leipzig, Leipzig, Deutschland
| | - Ulf Thiemann
- Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LVR-Klinik Bonn, Bonn, Deutschland
| | - Peter J Uhlhaas
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
- Institute of Neuroscience and Psychology, University of Glasgow, UK
| | | | - Christoph U Correll
- Deutsches Zentrum für Psychische Gesundheit, Standort Berlin, Deutschland
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Deutschland
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - das Care-Konsortium
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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2
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Alliende LM, Strauss GP, Yang LH, Mittal VA. Perceptions of stigma in youth at clinical high risk for psychosis and depressive symptomatology. Schizophr Res 2024; 269:79-85. [PMID: 38754312 DOI: 10.1016/j.schres.2024.04.023] [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: 11/23/2023] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Abstract
It is unclear what types of stigma youth at clinical high risk for psychosis (CHR) experience, and the relationship between them and symptomatology. 94 CHR youth, and a control group of 45 youth with no psychosis spectrum symptoms (NP) were rated for perceived devaluation (i.e. negative views from others) and internalized mental health stigma (i.e. the extent to which they would agree with said views) as well as positive and mood symptomatology. CHR youth reported stigma more frequently than the NP group (χ2(1) = 53.55, p < .001) and at higher levels (perceived devaluation: t (137) = 8.54, p < .001; internalized stigma: t (137) = 7.48, p < .001). Surprisingly, in the CHR group, positive symptoms held no significant relationship to stigma measures. However, ratings of perceived devaluation stigma were associated with depressive symptomatology (β = 0.27, t = 2.68, p = .0087) and depression scores were conversely associated with perceived devaluation stigma (β = 0.30, t = 2.05, p = .043). These findings speak to the relationship between depressive symptomatology and perceived devaluation stigma in CHR youth. Perceived devaluation stigma showed greater clinical significance and could have different mechanisms than internalized stigma in CHR youth. It is also noteworthy that while positive symptoms play a central role in defining the CHR syndrome, they seem less relevant to the experience of stigma than mood symptoms. These findings highlight the importance of interventions aimed at ameliorating youth's exposure to negative views about mental health as those managing depressive symptomatology.
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Affiliation(s)
| | | | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA
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Kingston JL, Ellett L, Thompson EC, Gaudiano BA, Krkovic K. A Child-Parent Dyad Study on Adolescent Paranoia and the Influence of Adverse Life Events, Bullying, Parenting Stress, and Family Support. Schizophr Bull 2023; 49:1486-1493. [PMID: 37621256 PMCID: PMC10686324 DOI: 10.1093/schbul/sbad119] [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: 08/26/2023]
Abstract
BACKGROUND Paranoid beliefs commonly occur in the general adolescent population. Exposure to adverse life events (ALEs) and/or bullying are important environmental risk factors. The extent to which others, especially parents, are available to help a young person cope with stressful situations may offset this risk. STUDY DESIGN A cross-sectional adolescent-parent dyad design (n = 142 pairs) was used to test whether an adolescent's perception of being supported by their family, and/or the parent's perception of stress and burden in their parenting role, moderated the association between environmental risk and adolescent paranoid beliefs. STUDY RESULTS Moderation analysis indicated that ALEs were significantly associated with adolescent paranoid beliefs when parents reported high stress and burden in their parenting role. Conversely, at low and moderate levels of parental stress, ALEs were unrelated to paranoid beliefs. Bullying was strongly associated with paranoia, with no moderation effects. The adolescent's perception of support within their family had no moderating effects. CONCLUSIONS Findings indicate that the focus of prevention should be shifted beyond just families of adolescents who are experiencing psychosis and/or have high "at-risk" profiles, to families of adolescents exposed to ALEs. Targeted support for parents to help reduce parental stress and burden, and help foster protective family environments even in the face of ALEs, is an important avenue for reducing the risk of paranoid beliefs in adolescents. Further research is required to better understand how to offset the deleterious effect of bullying on paranoid beliefs in adolescents.
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Affiliation(s)
- Jessica L Kingston
- Doctorate in Clinical Psychology, Department of Psychology, Royal Holloway, University of London, Surrey, UK
| | - Lyn Ellett
- School of Psychology, University of Southampton, Southampton, UK
| | - Elizabeth C Thompson
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Brandon A Gaudiano
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Katarina Krkovic
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
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Myers NL, Wilkey J, Chacon M, Hutnyan M, Janssen C, Tarvin H, Cohen D, Holmes I, Klodnick VV, Mihiret MA, Reznik SJ, Shimizu TK, Stein E, Lopez MA. Perspectives of young adults diagnosed with early psychosis using coordinated specialty care in Texas on substance use and substance use interventions. Early Interv Psychiatry 2023:10.1111/eip.13488. [PMID: 38030586 PMCID: PMC11133765 DOI: 10.1111/eip.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/29/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
AIM Despite known prevalence of substance use (SU) among young people experiencing early psychosis and increasing evidence for the relationship between certain substances (e.g., cannabis) and psychosis, there are no specialized interventions developed for effectively addressing substance use among young people participating in coordinated early psychosis services. This study elicited the perspectives of young people with early psychosis participating in Coordinated Specialty Care (CSC) programs about their substance use, including their motivations and concerns around their use, and their ideas on how to best support young people who are interested in reducing or quitting substance use. METHODS We recruited young adults (ages 18 to 30) from CSC programs across Texas through flyers sent to program staff inviting young persons willing to talk about substance use to engage in a 60-90 min person-centered, semi-structured, audio-recorded Zoom interview. RESULTS A total of 22 young adults were recruited and 18 completed an interview. Participants described mixed positive and negative responses to substance use, and while many understood the importance of discontinuing substance use, many expressed ambivalence related to social, contextual, mental and physical factors that motivated them to keep using. Participants desired practical substance use information, opportunities to explore their substance use ambivalence in supportive relationships, positive peer communities to support healthy choices, help engage, with work, school, and hobbies, and strategies for addressing psychological and physical pain that did not include substance use. CONCLUSION Study findings illuminate what motivates young people with early psychosis to initiate, continue, or cut back on substance use, and ideas for CSC practices for exploring substances and helping young people to reduce substance use.
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Affiliation(s)
- Neely Laurenzo Myers
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Justin Wilkey
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Marne Chacon
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Matthew Hutnyan
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Claire Janssen
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Halle Tarvin
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Deborah Cohen
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | - Imani Holmes
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Vanessa Vorhies Klodnick
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | - Mesganaw A Mihiret
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Samantha J Reznik
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
| | | | - Emily Stein
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Molly A Lopez
- The University of Texas at Austin, Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, Austin, Texas, USA
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Adrien V, Liewig J, Diot T, Ferreri F, Mouchabac S, Dubertret C, Bourgin J. Association between family functioning and psychotic transition in ultra-high risk adolescents and young adults. Front Psychiatry 2023; 14:1177311. [PMID: 37415693 PMCID: PMC10320389 DOI: 10.3389/fpsyt.2023.1177311] [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: 03/01/2023] [Accepted: 05/24/2023] [Indexed: 07/08/2023] Open
Abstract
Background Psychotic transition (PT) is a crucial stage in schizophrenia. The Comprehensive Assessment of At-Risk Mental States (CAARMS) scale can be used to identify individuals at ultra-high risk (UHR) for psychosis and to evaluate their risk of PT. Many environmental and genetic factors have been identified as contributing to the development and decompensation of schizophrenia. This study aimed to determine if the quality of family functioning is associated with PT risk in UHR individuals aged between 11 and 25 years after 1 year of follow-up. Methods From January to November 2017, 45 patients aged 12 to 25 consulting for psychiatric reasons were included. Twenty-six were classified as UHR of PT at the CAARMS. Family functioning was assessed by the Family Assessment Device-Global Functioning (FAD-GF). Thirty-seven of these patients (30% men, mean age 16 ± 2.5) were reassessed at 8-14 months of recruitment. Survival analysis was used to examine the impact of family functioning on PT risk. Results A total of 40% of UHR patients were classified as psychotic at reassessment. Survival analysis showed that better family functioning is a significant protective factor for PT in this population. Discussion This result suggests that the global family functioning has an impact at 1 year on the risk of PT in the population of adolescents and young adults who consult the hospital for psychiatric reasons. A family intervention may be effective in reducing PT risk in this population and should be considered as a potential therapeutic option.
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Affiliation(s)
- Vladimir Adrien
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neuroscience (iCRIN), Paris Brain Institute, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Justine Liewig
- Department of Child and Adolescent Psychiatry, Nord-Essonne Hospital, Bures-sur-Yvette, France
| | - Thomas Diot
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
| | - Florian Ferreri
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neuroscience (iCRIN), Paris Brain Institute, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Stephane Mouchabac
- AP-HP, Department of Psychiatry, Saint-Antoine Hospital, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neuroscience (iCRIN), Paris Brain Institute, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Caroline Dubertret
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Université Paris Cité, Faculté de Médecine, Colombes, France
| | - Julie Bourgin
- Department of Child and Adolescent Psychiatry, Nord-Essonne Hospital, Bures-sur-Yvette, France
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Zhou L, Lee SH, Cao Y. An empirical analysis of sport for mental health from the perspective of a factor analysis approach. Front Psychol 2022; 13:960255. [PMID: 35978771 PMCID: PMC9377415 DOI: 10.3389/fpsyg.2022.960255] [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: 06/02/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Mental health is a kind of emotional state, a good psychological state can have a positive impact on a person, physical exercise can have a positive impact on the psychological state of college students, prevent the generation of negative emotions, improve the bad emotional state, and then promote the mental health of college students. Health is an inevitable requirement to promote the all-round development of people and a basic condition for economic and social development. Health education should be incorporated into the national education system to promote the national health of the people through sports. Young people are the main force and backbone of national and social development. In order to realize the Chinese dream of great rejuvenation, we must attach importance to the development of young people and the physical and mental health of young people. In the process of compulsory education, middle school and high school period is a key stage in the gradual formation and development of students' psychology and body, but due to the large audience of China's education, the competition is more intense, which inevitably causes a lot of students to focus on exam-oriented education and neglect physical health, especially in recent years, the mental health issues of increasing concern. Through the research situation of mental health in China and the concept of mental health quality, this paper analyzes the problems of sports and mental health, and puts forward some corresponding suggestions for the problems, which has reference significance for promoting students' mental health.
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Affiliation(s)
- Lan Zhou
- Department of Physical Education, Northwest University, Xi'an, China
- *Correspondence: Lan Zhou
| | - Sang-Ho Lee
- College of Arts and Sports, Dong-A University, Busan, South Korea
| | - Youshen Cao
- College of Arts and Sports, Dong-A University, Busan, South Korea
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7
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Akouri-Shan L, DeLuca JS, Pitts SC, Jay SY, Redman SL, Petti E, Bridgwater MA, Rakhshan Rouhakhtar PJ, Klaunig MJ, Chibani D, Martin EA, Reeves GM, Schiffman J. Internalized stigma mediates the relation between psychosis-risk symptoms and subjective quality of life in a help-seeking sample. Schizophr Res 2022; 241:298-305. [PMID: 35220169 DOI: 10.1016/j.schres.2022.02.022] [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: 03/30/2021] [Revised: 01/26/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
Abstract
Subjective quality of life can be compromised in individuals with psychosis-risk symptoms, with poorer quality of life being associated with worse functioning and later transition to psychosis. Individuals who experience psychosis-related symptoms also tend to endorse more internalized (or self-) mental health stigma when compared to controls, potentially contributing to delays in seeking treatment and increased duration of untreated psychosis, as well as interfering with treatment engagement and retention in those already receiving care. Despite these findings, and the growing recognition for prevention in earlier phases of psychotic illness, few studies have examined the relation between psychosis-risk symptoms, internalized stigma, and subjective quality of life in a younger, help-seeking sample. The present study examined whether internalized stigma mediates the relation between psychosis-risk symptoms and subjective quality of life in a transdiagnostic sample of youth (M age = 17.93, SD = 2.90) at clinical high-risk for psychosis (CHR), with early psychosis, or with non-psychotic disorders (N = 72). Psychosis-risk symptom severity was assessed using the Structured Interview for Psychosis-Risk Syndromes (SIPS). Internalized stigma was assessed using the Internalized Stigma of Mental Illness Inventory (ISMI), and subjective quality of life was assessed using the Youth Quality of Life Instrument - Short Form (YQOL-SF). Internalized stigma fully mediated the relation between psychosis-risk symptoms and subjective quality of life across the full sample (p < .05, f2 = 0.06). Findings suggest that internalized stigma may be an important target in efforts to improve quality of life for individuals in early stages of psychosis.
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Affiliation(s)
- LeeAnn Akouri-Shan
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore 21250, MD, USA
| | - Joseph S DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1399 Park Ave., New York 10029, NY, USA
| | - Steven C Pitts
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore 21250, MD, USA
| | - Samantha Y Jay
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore 21250, MD, USA
| | - Samantha L Redman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore 21250, MD, USA
| | - Emily Petti
- Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine 92697, CA, USA
| | - Miranda A Bridgwater
- Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine 92697, CA, USA
| | - Pamela J Rakhshan Rouhakhtar
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore 21250, MD, USA; Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 701 W. Pratt St., Baltimore 21201, MD, USA
| | - Mallory J Klaunig
- Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine 92697, CA, USA
| | - Doha Chibani
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore 21250, MD, USA
| | - Elizabeth A Martin
- Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine 92697, CA, USA
| | - Gloria M Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 701 W. Pratt St., Baltimore 21201, MD, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine 92697, CA, USA.
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8
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DeLuca JS, Novacek DM, Adery LH, Herrera SN, Landa Y, Corcoran CM, Walker EF. Equity in Mental Health Services for Youth at Clinical High Risk for Psychosis: Considering Marginalized Identities and Stressors. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:176-197. [PMID: 35815004 PMCID: PMC9258423 DOI: 10.1080/23794925.2022.2042874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Prevention and early intervention programs have been initiated worldwide to serve youth at Clinical High Risk for Psychosis (CHR-P), who are adolescents and young adults experiencing subclinical psychosis and functional impairment. The primary goals of these efforts are to prevent or mitigate the onset of clinical psychosis, while also treating comorbid issues. It is important to consider issues of diversity, equity, and inclusion in CHR-P work, especially as these programs continue to proliferate around the world. Further, there is a long history in psychiatry of misdiagnosing and mistreating psychosis in individuals from racial and ethnic minority groups. Although there have been significant developments in early intervention psychosis work, there is evidence that marginalized groups are underserved by current CHR-P screening and intervention efforts. These issues are compounded by the contexts of continued social marginalization and significant mental health disparities in general child/adolescent services. Within this narrative review and call to action, we use an intersectional and minority stress lens to review and discuss current issues related to equity in CHR-P services, offer evidence-based recommendations, and propose next steps. In particular, our intersectional and minority stress lenses incorporate perspectives for a range of marginalized and underserved identities related to race, ethnicity, and culture; faith; immigration status; geography/residence; gender identity; sexual orientation; socioeconomic status/class; and ability status.
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Affiliation(s)
- Joseph S. DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
| | - Derek M. Novacek
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, , Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Laura H. Adery
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Shaynna N. Herrera
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
| | - Yulia Landa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
- New York Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
- New York Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Elaine F. Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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9
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Roncone R, Giusti L, Bianchini V, Casacchia M, Carpiniello B, Aguglia E, Altamura M, Barlati S, Bellomo A, Bucci P, Cascino G, Concerto C, Fagiolini A, Marchesi C, Monteleone AM, Pinna F, Siracusano A, Galderisi S. Family functioning and personal growth in Italian caregivers living with a family member affected by schizophrenia: Results of an add-on study of the Italian network for research on psychoses. Front Psychiatry 2022; 13:1042657. [PMID: 36713911 PMCID: PMC9880038 DOI: 10.3389/fpsyt.2022.1042657] [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: 09/12/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
To date, the role of family members in caring for relatives affected by schizophrenia has focused largely on the negative aspects of impact of the illness. The present study aimed to: (1) assess family functioning and burden of care in caregivers living in Northern, Central, and Southern Italy who looked after subjects affected by chronic schizophrenia; (2) evaluate the relationship between aspects of family functioning and burden of care, in particular personal growth (PG) of caregivers; and (3) identify variables capable of affecting PG of caregivers. A total of 136 caregivers (mean length of illness of family member more than 20 years) were recruited from 9 Italian research sites and evaluated in terms of "positive" family functioning-problem-solving, communication skills and personal goals Family Functioning Questionnaire (FFQ), burden of care, and PG Family Problems Questionnaire (FPQ). Caregivers reported an overall good family functioning with a relatively low objective and subjective burden of care. The latter was positively correlated with length of illness, with women showing a higher subjective burden than men. Reduced problem-solving skills and ability of each family member to pursue personal goals were both associated with reduced objective and subjective burden which, conversely, were both increased by inadequate support and scarce positive comments from relatives and friends. Approximately 50% of caregivers stated that "they had learned something positive from the situation," highlighting a statistically higher proportion of caregivers in southern Italy than in northern and central Italy. Caregivers' PG was associated with good family functioning, adequate professional support, and positive comments. PG also seemed to be positively influenced by support from relatives and friends (O.R. 14.306). The numerous challenges and positive aspects associated with caregiving should be duly acknowledged by mental health services and integrated into routine clinical assessment and intervention framework.
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Affiliation(s)
- Rita Roncone
- Psychiatry Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Laura Giusti
- Psychiatry Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valeria Bianchini
- Psychiatry Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo Casacchia
- Psychiatry Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Bernardo Carpiniello
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eugenio Aguglia
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Stefano Barlati
- Psychiatric Unit, Department of Clinical and Experimental Sciences, Brescia University, Brescia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Carmen Concerto
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Carlo Marchesi
- Psychiatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alberto Siracusano
- Psychiatry and Clinical Psychology Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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10
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DeLuca JS, Yang LH, Lucksted AA, Yanos PT, DeVylder J, Anglin DM, Landa Y, Corcoran CM. Reducing Stigma Among Youth at Risk for Psychosis: A Call to Action. Schizophr Bull 2021; 47:1512-1514. [PMID: 34401924 PMCID: PMC8530387 DOI: 10.1093/schbul/sbab098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joseph S DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA,To whom correspondence should be addressed; Joseph S. DeLuca, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1399 Park Avenue, New York, NY 10029, USA; tel: 212-659-8838; fax: 212-996-8931, e-mail:
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Alicia A Lucksted
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Philip T Yanos
- Department of Psychology, John Jay College of Criminal Justice, City University of New York (CUNY) and CUNY Graduate Center, New York, NY 10019, USA
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, NY 10023, USA
| | - Deidre M Anglin
- Department of Psychology, The City College of New York, CUNY, New York, NY 10031, USA
| | - Yulia Landa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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