Meaningful Relationships in Community and Clinical Samples: Their Importance for Mental Health

Is the Exoneration-Forgiveness Distinction in Contextual Therapy Evident in Practice, and What Can We Learn From It?

This article compares exoneration with the correlated concept of forgiveness. According to Contextual Therapy, a fundamental distinction exists between the two. It states that exoneration depends on an adult reassessment of history, resulting in the offender being freed of guilt. Conversely, according to Contextual Therapy, forgiveness is beyond reassessment and relies on the generosity of the forgiver while retaining the assumption of guilt on the part of the wrongdoer. After briefly introducing and concisely overviewing contextual theory, the five core elements of exoneration are identified as (a) an intrapersonal, interpersonal, or posthumous process; (b) motivated by loyalty and obligation; (c) recognition of suffered injustice; and (d) an adult reassessment, leading to (e) a promise of improvement. Then, the core elements are compared with the findings of a previously conducted international phenomenological research study on forgiveness processes between children and parents. Instead of finding evidence of the distinction between exoneration and forgiveness as Contextual Therapy proposes, this article confirms the importance of the five identified elements for both exoneration and forgiveness.

Factors which influence social connection among cancer caregivers: an exploratory, interview study

BACKGROUND/AIMS

Social connectedness is increasingly recognised as influencing health outcomes in cancer caregivers; however, there is little understanding of factors which foster feelings of social connectedness among caregivers when providing care. We sought to examine from the caregivers' perspective, factors which contribute to perceived social connection when providing care to someone with cancer.

METHODS

Semi-structured interviews were conducted with 20 caregivers of people with cancer. Participants were recruited through social media and were eligible if they were aged 18 + years and had provided care to someone with cancer in the preceding 3 years. Data were analysed thematically using NVivo.

RESULTS

Following thematic analysis of interview data, six overarching themes emerged detailing caregivers' experiences with social support, networks, and connectedness. Themes included: people in caregivers' social networks and communication frequency, supportive communication with people in social networks, challenges with talking with others and seeking support, receiving instrumental support from social networks, impact of the carer role on friendships and community activities, and factors which fostered perceived connectedness.

CONCLUSIONS

For caregivers of people with cancer, our qualitative findings suggest the importance of receiving emotional and instrumental support from social networks to cope with, and alleviate the stress and strain of providing care. Development and empirical testing of strategies and interventions that improve social support seeking and subsequently perceived connectedness among caregivers are recommended to improve health and wellbeing.

Perceived attitudes toward LGBTQ+ physicians among Thai patients with psychiatric disorder: A multiregional cross-sectional study

PURPOSE

This study aims to examine attitudes toward LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and more) physicians among Thai psychiatric patients and to identify associated factors across three regions of Thailand.

PATIENTS AND METHODS

A cross-sectional survey was conducted from June to August 2023 in Central, Northern, and Southern Thailand. The Attitudes Toward LGBTQ+ Physician Questionnaire and a patient-doctor relationship questionnaire were utilized. Data analysis involved descriptive statistics and linear regression.

RESULTS

The study included 543 participants with a median age of 37 years (IQR 26-52), predominantly female (68.9%) and Buddhist (78.1%). The median score for perceived attitudes toward LGBTQ+ physicians was 86 (IQR 73.0-95.5), with significant regional variations. Most participants perceived LGBTQ+ physicians as normal (85.5%) and integral to society (94.5%). A significant portion disagreed with the idea that being an LGBTQ+ physician was sinful (85.3%) or immoral (84.0%). However, 20.3% expressed discomfort with the possibility of LGBTQ+ physicians conducting private physical examinations. Lower perceived attitudes were associated with older age and being Muslim. Conversely, higher education, female gender, having LGBTQ+ connections, and a reported gender non-conformity showed a correlation with more positive attitudes.

CONCLUSION

Thai psychiatric patients generally hold positive attitudes toward LGBTQ+ physicians, though demographic factors influence these attitudes. There needs to be a particular focus on improving attitudes regarding conducting private physical examinations to maximize patient comfort and trust.

Generative artificial intelligence (GenAI) and decision-making: Legal & ethical hurdles for implementation in mental health

This article argues that significant risks are being taken with using GenAI in mental health that should be assessed urgently. It recommends that guidelines for using generative artificial intelligence (GenAI) in mental health care must be established promptly. Currently, clinicians using chatbots without appropriate approval risk undermining legal protections for patients. This could harm the patient and undermine the standards of the profession, undermining trust in an area where human involvement in decision-making is critical. To explore these concerns, this paper is divided into three parts. First, it examines the needs of patients in mental health. Second, it explores the potential benefits of GenAI in mental health and highlights the risks of its use as it pertains to patient needs. Third, it notes the ethical and legal concerns around data use and medical liability that require careful attention. The impact of the European Union's (EU) Artificial Intelligence Act (AI-Act) is also considered. It will be seen that these laws are insufficient in the context of mental health. As such, the paper recommends that guidelines should be developed to help resolve the existing legal gaps until codified rules are established.

Perceived attitudes toward LGBTQ + physicians among individuals with psychiatric illness in the religiously diverse Southern Region of Thailand: a multihospital-based survey

OBJECTIVES

This study purposed to analyze perceived attitudes toward LGBTQ + physicians and related factors among individuals with psychiatric illnesses in southern Thailand.

MATERIALS AND METHODS

From May to July 2023, a cross-sectional study was conducted at four psychiatric outpatient clinics in Southern Thailand. The questionnaires utilized were: 1) a demographic information questionnaire, 2) a questionnaire regarding attitudes toward LGBTQ + physicians, 3) a questionnaire evaluating individuals' attitudes toward LGBTQ + physicians while receiving medical attention, and 4) a patient-doctor relationship questionnaire. All data were analyzed using descriptive statistics, and the factors associated with perceived attitudes toward LGBTQ + physicians were analyzed using the Wilcoxon rank sum test, the Kruskal-Wallis test, and linear regressions. The analyses were conducted using the R Foundation for Statistical Computing software, version 4.3.1. Statistical significance was defined as a p-value of less than 0.05.

RESULTS

Among our 542 participants, the mean age was 36.3 ± 14.1 years. The majority were female (64.6%), Buddhist (62.4%), and diagnosed with depression (46.3%). Approximately three-quarters showed a good doctor-patient relationship (74.0%). The median (IQR) score of the perceived attitudes toward LGBTQ + physicians was 75 (66, 88). Predominantly, the LGBTQ + physicians were perceived as normal (76.3%) and being a viable part of society (88.7%). Moreover, our participants disagreed with the view that being an LGBTQ + physician was a sin (70.6%) or immoral (68.2%). They felt comfortable during history taking (79.0%), physical examination not involving private parts of the body (72.5%), and management for both medical (78.4%) and psychiatric conditions (81.4%) at the hands of LGBTQ + physicians. However, they reported feeling uncomfortable during history taking involving private matters (6.3%) and the physical examination of private parts (16.4%). Older age, absence of LGBTQ + close relatives/friends, and being a Muslim were associated with lower scores of perceived attitudes toward LGBTQ + physicians. Conversely, a higher level of education and a reported mismatch between the patient's sex and gender were associated with higher scores.

CONCLUSIONS

Most participants reported positive perceived attitudes toward LGBTQ + physicians. However, some age groups and adherents of Islam showed lower perceived attitude scores and reported feeling uncomfortable receiving medical treatment from LGBTQ + physicians. On the one hand, LGBTQ + physicians have cause to be concerned about this point; on the other hand, finding appropriate approaches to promote positive attitudes toward LGBTQ + physicians among these groups of people remains a necessity.

Community prevalence of psychiatric disorders: Findings from a nationwide survey in Bangladesh

OBJECTIVE

To determine the community prevalence of psychiatric disorders in adult population and describe the prevalence by age, men-women, urban-rural strata.

METHODS

A nationwide household survey was conducted in 2019 where adults aged 18 years and above were selected by a multicentric, stratified, systematic random approach. The Self-Reporting Questionnaire (SRQ) was used for screening purpose and screened positive individuals were interviewed by research psychiatrists and diagnosed according the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.

RESULTS

Overall adult response rate for this survey was 90.4%. In total, of the 7270 adults, 1570 (21.6%) came positive on the SRQ. Overall prevalence of mental disorders found was 18.7% ((95% CI: 17.4%-20.0%). Women reported higher prevalence of psychiatric disorders than men (21.5% vs 15.7%). No significant difference was observed between urban and rural residents (18.9% vs 18.7%). Most common psychiatric disorders found were depressive disorders (6.7%), anxiety disorders (4.7%), somatic symptom and related disorders (2.3%), sleep-wake disorders (1%) and schizophrenia spectrum disorders (1%).

CONCLUSIONS

The study revealed that a substatial proportion of adults received diagnoses for psychiatric disorders. Once again, our findings emphasize the need for development of comprehensive mental healthcare services.

Studying Daily Social Interaction Quantity and Quality in Relation to Depression Change: A Multi-Phase Experience Sampling Study

Day-to-day social life and mental health are intertwined. Yet, no study to date has assessed how the quantity and quality of social interactions in daily life are associated with changes in depressive symptoms. This study examines these links using multiple-timescale data (iSHAIB data set; N = 133), where the level of depressive symptoms was measured before and after three 21-day periods of event-contingent experience sampling of individuals' interpersonal interactions (T = 64,112). We find weak between-person effects for interaction quantity and perceiving interpersonal warmth of others on changes in depressive symptoms over the 21-day period, but strong and robust evidence for overwarming-a novel construct representing the self-perceived difference between one's own and interaction partner's level of interpersonal warmth. The findings highlight the important role qualitative aspects of social interactions may play in the progression of individuals' depressive symptoms.