Mental Healthcare Needs and Experiences of LGBT+ Individuals in Malaysia: Utility, Enablers, and Barriers

Access to mental healthcare is undoubtedly of major importance for LGBT+ people worldwide, given the high prevalence of mental health difficulties due to minority stress exposures. This study drew mixed-method survey data from the community-based KAMI Survey (n = 696) to examine the enablers, barriers, and unmet needs experiences of LGBT+ individuals in accessing mental healthcare services in Malaysia. First, we present findings from a series of descriptive analyses for sociodemographic differences in unmet needs for mental healthcare, barriers, and satisfaction levels with different types of mental healthcare. Next, we conducted an inductive thematic analysis of open-text comments (n = 273), with relevance drawn to Andersen's Behavioural Model of Healthcare. More than a quarter (29.5%) reported an unmet need for mental healthcare, and some groups (younger, asexual or queer, or participants living in non-major cities) reported higher unmet needs. More than three-fifths (60.5%) reported not knowing where to find culturally safe mental health professionals. The thematic analysis uncovered key contextual (e.g., mental health practitioners' stance, stigma, collaborative client-care) and individual (e.g., positive expectation of mental health services and anticipated stigma) attributes that influence healthcare experiences. Participants also identified resources that facilitate healthcare utilisation, such as affordability, availability of suitable professionals, and geographical considerations. The implications of our findings for the mental healthcare practices in Malaysia were outlined.

Public perception of psychiatry, psychology and mental health professionals: a 15-year analysis

Background

X (previously known as "Twitter") serves as a platform for open discussions on mental health, providing an avenue for scrutinizing public perspectives regarding psychiatry, psychology and their associated professionals.

Objective

To analyze the conversations happening on X about psychiatrists, psychologists, and their respective disciplines to understand how the public perception of these professionals and specialties has evolved over the last 15 years.

Methods

We collected and analyzed all tweets posted in English or Spanish between 2007 and 2023 referring to psychiatry, psychology, neurology, mental health, psychiatrist, psychologist, or neurologist using advance topic modelling and sentiment analysis.

Results

A total of 403,767 tweets were analyzed, 155,217 (38%) were in English and 248,550 (62%) in Spanish. Tweets about mental health and mental health professionals and disciplines showed a consistent volume between 2011 and 2016, followed by a gradual increase from 2016 through 2022. The proportion of tweets discussing mental health doubled from 2016 to 2022, increasing from 20% to 67% in Spanish and from 15% to 45% in English. Several differences were observed on the volume of tweets overtime depending on the language they were written. Users associated each term with varied topics, such as seeking for help and recommendation for therapy, self-help resources, medication and side effects, suicide prevention, mental health in times of crisis, among others. The number of tweets mentioning these topics increased by 5-10% from 2016 to 2022, indicating a growing interest among the population. Emotional analysis showed most of the topics were associated with fear and anger.

Conclusion

The increasing trend in discussions about mental health and the related professionals and disciplines over time may signify an elevated collective awareness of mental health. Gaining insights into the topics around these matters and user's corresponding emotions towards them presents an opportunity to combat the stigma surrounding mental health more effectively.

Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study

BACKGROUND

The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services.

OBJECTIVE

The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings.

METHODS

This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital).

RESULTS

From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66).

CONCLUSIONS

These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients.

Psychologists' experiences with telepsychology during the COVID-19 pandemic in South Africa

Background

During the COVID-19 pandemic, South African psychologists started to use telepsychology to continue providing services. However, diverse factors may influence psychologists' decisions regarding the use of telepsychology.

Aim

To investigate South African psychologists' experiences with using telepsychology during the COVID-19 pandemic.

Setting

Health Professions Council of South Africa (HPCSA)-registered psychologists practising in South Africa.

Methods

A quantitative, cross-sectional study was conducted. Psychologists were invited to complete an online survey on the REDCap platform. Convenience sampling was used for respondent selection (n = 179). The study explored demographic variables, telepsychology use, changes in psychotherapy format, guidelines, ethical considerations, training, socio-economic factors, and individual patient and psychotherapist factors. Descriptive statistics, including categorical variables (frequencies and percentages) and numerical variables (medians and percentiles) were utilised for the data analysis. A bivariate analysis with backward selection was subsequently used, and significant variables were integrated into the logistic regression model.

Results

Most respondents (84.8%) used telepsychology, with 72.8% considering it a positive experience. Private psychologists used electronic means for delivering services significantly more than public sector psychologists. The public sector psychologists had more challenges relating to changes in the therapeutic format, additional training requirements and technology access.

Conclusion

During the COVID-19 pandemic, psychologists turned to telepsychology as a valuable tool for providing services while navigating the unique challenges it presented.

Contribution

This study provides insights into the utility of telepsychology in the South African context during COVID-19. It underscores the experiences, importance of guidelines, and needs regarding training and technology access among psychologists.

Homicides of psychologists, physicians, nurses, pharmacists, social workers, and other health professionals: National Violent Death Reporting System data 2003-2020

OBJECTIVE

Homicide is the extreme endpoint along the continuum of interpersonal violence. Violence in healthcare settings and directed toward healthcare workers has been a growing concern. Analysis of health professionals' homicides is needed to inform prevention interventions.

METHODS

Decedent numbers, age, and sex in the National Violent Death Reporting System are reported for 10 types of health professionals: advance practice registered nurses, dentists, nurses, pharmacists, physicians, physician assistants, psychiatrists, psychologists, social workers, and veterinarians.

RESULTS

Between 2003 and 2020, 944 homicides of these professionals were reported to the NVDRS. Nearly 80% of victims were women; 53% of homicides involved guns. Nurses, social workers, physicians, and pharmacists comprised the most victims. In 2020, nurses, social workers, pharmacists, and psychologists had the highest homicide rates relative to their workforce size. Few of these homicides were related to professionals' work. The number of homicides within these professions correlated highly with the size of professions' workforces.

CONCLUSIONS

Health professionals' homicides constitute a small proportion of US homicides generally at lower rates than seen in the general population. Age is likely one of the protective factors. Future, more comprehensive data will provide greater insights into emerging trends to inform strategies to mitigate homicide risk in health professionals. Prevention needs to go beyond healthcare settings and address societal roots of violence.

The Gluten-Free Diet for Celiac Disease: Critical Insights to Better Understand Clinical Outcomes

The gluten-free diet (GFD) remains a complex paradigm in managing celiac disease (CeD) in children and adults, and there are many reasons why GFD adherence should be strict to improve outcomes. However, this is a challenging task for patients, since they need to have access to quality healthcare resources that facilitate optimal GFD adherence. Understanding the strengths and weaknesses of the GFD, tackling coexisting nutritional deficiencies, and dealing with complex situations, such as seronegative CeD or non-responsive CeD, all require the involvement of a multidisciplinary team. The short- and long-term follow-up of CeD patients should preferably be performed by a combined Gastroenterology and Nutrition service with well-defined quality standards and the multidisciplinary involvement of physicians, nurses, dietitians, and psychologists. Nutritional advice and counseling by an experienced dietitian can reduce the costs associated with long-term follow-up of CeD patients. Likewise, psychological interventions may be essential in specific scenarios where implementing and sustaining a lifelong GFD can cause a significant psychological burden for patients. This manuscript aims to provide guidelines to improve clinical practice in the follow-up and monitoring of CeD patients and provide information on the nutritional risks of an ill-advised GFD. Clinicians, biochemists, food technologists, dietitians, and psychologists with a global view of the disease have been involved in its writing.

[Child psychiatry chronicles, psychology in brief]

To work in a hospital is to believe in poetry, to grasp with wonder all the details that tie each person to an existence. However far-fetched they may be, they also contribute to enriching our belief in a world that can always be rewritten beyond the determinisms that would claim to assign tragedy.

Social construction of the image of the psychologist and of the patient: the role of implicit premises

Nowadays, there is a growing consideration of people's mental health through awareness programs, policies, and practices promoted by international aid agencies and non-governmental organizations. Psychologists and patients are major actors in mental health, and their images are socially co-constructed. Nevertheless, there is still a lot of confusion about who "psychologists" and "patients" are or what a psychologist does. This muddle may underline stereotypes and broadly speaking stigma related to mental health. Therefore, confronting directly the ideas of "psychologist" and "patient" could be a little step in challenging stereotypes and making order in the panorama of mental health. In our study, we focus on the implicit contextual premises that shape particular framings around which the images of the psychologist and of the patient are socially and culturally co-constructed. In order to reach this goal, we have investigated the discourses and the multiple points of view behind the social image of the psychologist and of the patient from different sources or contextual domains: psychology online forums, university websites, and an online survey. From a methodological perspective and according to the pragma-dialectical approach, we have identified all the different standpoints and arguments related to the various conceptions of the psychologist and the patient. We have made explicit the implicit premises that lay behind each argumentative inference via the Argumentum Model of Topics. Based on these analyses, we have reconstructed the distinct framings at stake in the different contextual domains. The findings show that implicit contextual premises have huge power in constructing stigmatization in the ideas that lay people have toward the image of the psychologist and of the patient. In particular, we have observed that the more the contextual domain is defined, the more institutional premises dominate over individual ones; on the contrary, in informal contextual domains, heterogenous individual premises are prominent. Our study underlines that it is only by substituting old implicit premises with new unimagined ones that we can change subjacent contextual premises at the very core of stigma and the prototypical world's images.

Psychological Effects of Professional Exposure to Trauma and Human Suffering: Systematic Review and Meta-Analysis

Over the past decades, a growing interest has emerged toward understanding the impact that the exposure to human suffering produces in mental health professionals, leading to the identification of three constructs: vicarious traumatization (VT), compassion fatigue (CF), and secondary trauma (ST). However, little is known about how these conditions affect psychologists. A systematic review and a meta-analysis were conducted to examine the evidence about the effects of occupational exposure to trauma and suffering in studies that included psychologists among their samples. Fifty-two studies were included comprising 10,233 participants. Overall, the results showed that most professionals did not experience relevant distress due to their work, yet some of them developed clinically significant symptoms (i.e., PTSD). However, solid conclusions could not be drawn due to the numerous methodological difficulties found in this research field (i.e., group heterogeneity, lack of comparison groups, and conceptual overlap). Thus, it is necessary to further investigate this topic with scientific rigor to understand these stressors and develop evidence-based interventions.

The Experiences of Australian School Mental Health Professionals during COVID-19 Lockdowns

Young people have emerged as one of the most impacted groups from the COVID-19 pandemic and related restrictions to daily activities, with disruptions to schooling, social interactions, and connections. Simultaneously, students' access to school mental health professionals were restricted or modified. The aim of this paper was to identify how school mental health professionals supported and addressed the mental health needs of young people during COVID-19 restrictions in Australia. School mental health professionals were surveyed during the 2020 lockdowns using a questionnaire designed by researchers in the United States of America. The innovations school mental health staff adopted to support students during lockdowns and remote learning were presented, including telehealth services, digital resources, and the online training and support they received/provided. The barriers and facilitators to providing counselling and assessment services during lockdowns were identified, including issues with providing psychometric assessments during remote learning, and ethical concerns when delivering remote counselling to students. Recommendations have been included, which address how school mental health professionals could be supported to assess and treat young people during future pandemics and school restrictions.

Integrated psychological care services within seizure settings: Key components and implementation factors among example services in four ILAE regions: A report by the ILAE Psychiatry Commission

Mental health comorbidities are prevalent and problematic in patients with seizures but often suboptimally managed. To address common gaps in care, the Integrated Mental Health Care Pathways Task Force of the International League Against Epilepsy (ILAE) Psychiatry Commission was tasked with providing education and guidance on the integration of mental health management (e.g., screening, referral, treatment) into routine seizure care. This report aims to describe a variety of established services in this area, with a specific focus on psychological care models. Services were identified by members of the ILAE Psychiatry Commission and authors of psychological intervention trials in epilepsy. A total of eight services met inclusion criteria and agreed to be showcased. They include three pediatric and five adult services located across four distinct ILAE regions (Europe, North America, Africa, Asia Oceania). The report describes the core operations, known outcomes, and implementation factors (i.e., barriers and facilitators) of these services. The report concludes with a set of practical tips for building successful psychological care services within seizure settings, including the importance of having local champions, clearly defining the scope of the service, and establishing sustainable funding models. The breadth of exemplars demonstrates how models tailored to the local environment and resources can be implemented. This report is an initial step to disseminate information regarding integrated mental health care within seizure care settings. Future work is needed to systematically examine both psychological and pharmacological care models and to further establish the evidence base in this area, especially around clinical impact, and cost-effectiveness.

A Qualitative Exploration of General Practitioners' Treatment Decision-Making for Depressive Symptoms

BACKGROUND

General practitioners (GPs) provide the most antidepressant prescriptions and psychologist referrals in Australia, yet little is known about how they decide between treatments for depressive symptoms.

AIMS

This study examined the decision cues that GPs use when deciding how to treat depressive symptoms and the meaning they attribute to these associations.

METHODS

Structured interviews were conducted with 16 Australian GPs in a "think-aloud" verbal protocol analysis format. The transcripts were analyzed using content coding and thematic analysis, informed by the dual processes model of decision making.

RESULTS

Participants associated prescribing antidepressants with severe depressive symptoms, and psychologist referrals were the preferred initial treatment provided patients were willing to engage. Four main themes emerged from the thematic analysis: 1) psychologist as default, 2) the risk is just too high, 3) medication as supplement, and 4) drivers of antidepressants. Contrary to previous findings, participants identified a strong heuristic association between depressive symptoms and psychologist referral. Antidepressant prescription was associated with severe symptoms, higher risk, and a cluster of cues that lead them away from psychologist referral.

CONCLUSIONS

Participants demonstrated an oversensitivity to depressive symptom severity, associating psychologist referrals with subclinical depressive symptoms, and starting antidepressants for suicidal ideation and significant functional decline.

HIGHLIGHTS

Psychologist referrals were the default preference for GPs when treating depressive symptoms, whereas antidepressants were reserved for patients with elevated risk from severe depressive symptoms and suicidal ideation.Participants' conceptualization of depression severity was oversensitive compared with treatment guidelines.Contrary to treatment guidelines, GPs in this study demonstrated their discomfort for referring patients with suicidal ideation to a psychologist without initiating antidepressants.GPs should consider whether patients within their mild to moderate assessment range can be treated exclusively with more cost-effective means than psychological therapy such as e-mental health programs, guided self-help, and lifestyle changes alone.

[Ethical and professional issues in the pandemic crisis]

Changes have accompanied the profession of psychologist in residential institutions for dependent elderly people after the Covid-19 crisis. Clinical interviews, assistance in changing life perspectives, support in painful moments and in letting go are concerned. Concrete actions can give meaning to daily life, as well as the contribution of a relaxation tool for the residents and the professionals of the establishment. Testimonial.

The association of state-level drug and opioid overdose deaths with the capacity of behavioural health professionals in the United States

As behavioural health occupations have diversified, more specialists such as social workers and counsellors are involved in providing substance use disorder treatment services. This study examined the association between changes in the number of different types of behavioural health professionals and changes in drug and opioid overdose deaths in the United States. Using publicly available state-level data from 2008 to 2017, we constructed multivariate linear regression models with state- and year fixed-effects to examine the effect of changes in the number of different types of behavioural health professionals (i.e. psychiatrists, psychologists, social workers and counsellors) on changes in drug and opioid overdose deaths at the state level, controlling for state population characteristics and other state-level factors. After controlling for confounding factors, a 1% increase in the number of social workers and counsellors at the state level was significantly associated with a 0.215% reduction in drug overdose deaths per 100,000 state population and with a 0.358% reduction in opioid overdose deaths per 100,000 state population. We did not find statistically significant associations between changes in drug overdose death rates and increases in the number of psychiatrists or psychologists alone. Our findings suggest efforts to facilitate a prepared and skilled workforce, such as expanding the capacity of social workers and counsellors, to maximise access to substance use disorder treatment services.

"You say you're inclusive, but can you show us?" The importance of cultural competence when working with sexual minorities in a mental health setting

OBJECTIVES

Sexual minorities experience higher rates of psychological distress than heterosexual people, likely due to minority stress. While rates of help-seeking by sexual minorities are high, sexual minorities report greater dissatisfaction with mental health service providers. This dissatisfaction may result from poor cultural competence practices. Our study sought to determine the importance of service provider cultural competence practices to a community sample of sexual minority people.

METHODS

Participants (n = 274) were sexual minority Australians recruited from affirming Facebook groups, organizations, and research-based organizations. To measure the importance of cultural competence practices, participants completed a modified online version of the Gay Affirming Practices Scale (GAP) and responded to open-ended questions.

RESULTS

Between 80% and 99% of participants endorsed each item on the GAP, indicating the importance of service providers demonstrating an array of culturally affirming practices. No significant associations were found between overall GAP score and age or sexual orientation, though further analyses revealed individual items on the GAP showed associations with age. A structured tabular thematic analysis, of open-ended participant responses, found positive attitudes, knowledge, and affirming practices were the three most important characteristics for service providers seeking to demonstrate culturally competent practices, mirroring the tripartite model (attitudes, knowledge, and skills) of cultural competence.

CONCLUSION

Recommendations for service providers to demonstrate cultural competence include: utilizing affirming practices such as inclusive language, increasing knowledge about sexual minorities, and utilizing education resources such as cultural competence workshops, lived experience stories, and seeking mentorship from service providers with expertise in working with sexual minorities.

[Caregivers' experiences with extreme prematurity]

Neonatal intensive care units receive very immature premature newborns. Mortality and morbidity rates remain high in this particularly fragile population. Caregivers involved with the child and his or her parents may experience moral distress. There are few studies on the experience of caregivers in these situations. Training, service architecture and sharing of experiences with specifically trained psychologists can improve this experience in these highly technical services.

Le psychologue face au Covid-19 : enquête exploratoire sur les pratiques en distanciel

Le contexte de la crise sanitaire a conduit les psychologues exerçant en institution ou en libéral à adapter leurs modalités de travail aux contraintes du confinement, notamment en recourant au distanciel. Cette enquête exploratoire a pour but de documenter cette évolution des pratiques, en lien avec le COVID 19. Une enquête en ligne a été réalisée auprès de praticiens, permettant de collecter 397 réponses. Les questions portaient sur le recours au distanciel (temps, activité), avant, pendant et après la période de crise. Si l’usage du distanciel était peu fréquent avant la crise, près de 3/4 des psychologues y ont recouru pendant, et un peu moins de la moitié pense y avoir recours après. Le temps consacré à ces pratiques dépend des missions et des statuts. Il est ainsi plus important pour les tâches administratives et les réunions que pour les prises en charges, et plus souvent envisagé par les psychologues libéraux que les salariés. Au-delà des constats généraux, la prise en compte du statut et du domaine d’activité permet une photographie des évolutions en cours.

[Supporting caregivers of children and adolescents with cancer]

Caring for a child or adolescent with cancer remains a perilous professional exercise. Caregivers are not only subject to high technical demands (oncological treatments, surgery and resuscitation, rehabilitation and equipment) but also to an emotional and relational involvement inherent to their function. However, the regulation and transformation of affects mobilize a great deal of psychic energy in professionals who must preserve their internal resources as best they can. The point of view of the clinical psychologist will shed light on the mechanisms to be considered in order to support the capacity of the teams to care for and accompany sick children and their families throughout the care process.

A qualitative study of the impact of a periacetabular osteotomy on patients' lives

AIMS

The aim of this study was to understand the experience of mature patients who undergo a periacetabular osteotomy (PAO), a major hip-preserving surgical procedure that treats symptomatic hip dysplasia by realigning the acetabulum. Our aim was to improve our understanding of how the operation affected the lives of patients and their families, with a long-term goal of improving their experience.

METHODS

We used a phenomenological approach with in-depth, semi-structured interviews to investigate the experience of seven female patients, aged between 25 and 40 years, who underwent a PAO. A modified homogeneity sampling approach coupled with criterion sampling was used. Inclusion criteria involved having at least one child at home and being in a committed relationship with a spouse or partner.

RESULTS

Analysis of interview transcripts revealed five major themes: feelings of frustration before having a treatment plan; fear of the operation; the importance of understanding the procedure in order to feel in control of their care; feelings of helplessness, dependence, and depression during recovery; and the need for support during recovery.

CONCLUSION

Our findings suggest that both the physical and psychosocial burdens of undergoing a PAO are great, with a major impact on the patient and their family. Many important issues lie outside the scope of what healthcare teams currently address. Cite this article: Bone Joint J 2022;104-B(7):781-785.

Putting your best face forward: Posing biases in psychologists' online portraits

When posing for portraits the position you adopt influences perceptions. As the left hemiface (controlled by the emotion-dominant right hemisphere) expresses emotion more intensely, left cheek portraits communicate stronger emotion than right cheek portraits. This phenomenon influences perceptions of both emotional expressivity and professional specialisation: while left cheek portraits emphasise emotion, right cheek portraits appear more scientific. When professionals upload photographs online to promote their services, the cheek shown consequently influences perceptions. Given the importance of empathy in establishing a therapeutic alliance, theoretically psychologists would benefit from choosing left cheek portraits to enhance their perceived emotionality. The present study thus examined psychologists' posing biases in photographs uploaded to online "Find a Psychologist" resources. Images (N = 1230) of psychologists were drawn from professional "Find a Psychologist" online databases, and coded for gender, portrait type and cheek shown. Results confirmed that psychologists show a left cheek bias, irrespective of gender and across portrait types (upper body, full body). This distinguishes psychologists from doctors and surgeons: past research reports no cheek bias in photos uploaded to "Find a Doctor" websites. The current findings suggest that psychologists may intuitively select left cheek images to enhance the communication of empathy to potential clients.

Barriers and enablers to implementing telehealth consultations in psycho-oncology

Objective

In response to the COVID‐19 pandemic, use of telehealth to deliver care was recommended across the Australian health system. This study aims to explore the barriers and enablers to delivery of psycho‐oncology services via telehealth and attitudes to use of telehealth in psycho‐oncology.

Methods

Twenty‐one psycho‐oncology clinicians participated in semi‐structured telephone interviews. Transcribed interviews were thematically analysed using the framework method.

Results

Three key themes were identified which described the overall experience of delivering psycho‐oncology services via telehealth: (1) Context Matters‐for whom is telehealth effective, when is it less effective; (2) Therapy content and telehealth implementation; (3) Recommendations for Sustainability.

Conclusions

These insights into the barriers and enablers to delivering psycho‐oncology services via telehealth inform future research and clinical practice. While there is support for the continued use of telehealth in psycho‐oncology, there are significant improvements needed to ensure effective implementation and continued benefit.

The Intervention Areas of the Psychologist in Pediatric Palliative Care: A Retrospective Analysis

Infants, children and adolescents with life-limiting and life-threatening disease need long-term care that may change according to disease's natural history. With the primary goal of quality of life, the psychologist of pediatric palliative care (PPC) network deals with a large variety of issues. Little consideration has been given to the variety of intervention areas of psychology in PPC that concern the whole life span of the patient and family. The PPC network is composed by a multidisciplinary team of palliative care specialists that intervenes at home, in the hospital and in every place where the patient is living. The network coordinates different public health services to respond to clinical, psychosocial and spiritual needs. In these scenarios, the psychological need is not a single event but a moment inserted in the complexity of the child's needs. This retrospective monocentric project consists of an analysis of characteristics of psychological interventions in our PPC service. The time frame taken into consideration is 2019-2020, analyzing the clinical records of 186 patients of Pediatric Palliative Care and Pain Service of Veneto Region (Italy). The areas that emerged in the analysis show how the intervention of the psychologist in PPC does not concern only end-of-life, but a series of topics that are significant for the family to guarantee psycho-social wellbeing oriented toward the best quality of life. In conclusion, these different topics highlight the complexity of the child and family experience. This variety must be taken into consideration, the psychologist must increase holistic support with a dedicated skills curriculum.

Suicides of psychologists and other health professionals: National Violent Death Reporting System data, 2003-2018

Suicide is a prevalent problem among health professionals, with suicide rates often described as exceeding that of the general population. The literature addressing suicide of psychologists is limited, including its epidemiological estimates. This study explored suicide rates in psychologists by examining the National Violent Death Reporting System (NVDRS), the Centers for Disease Control and Prevention's data set of U.S. violent deaths. Data were examined from participating states from 2003 to 2018. Trends in suicide deaths longitudinally were examined. Suicide decedents were characterized by examining demographics, region of residence, method of suicide, mental health, suicidal ideation, and suicidal behavior histories. Psychologists' suicide rates are compared to those of other health professionals. Since its inception, the NVDRS identified 159 cases of psychologist suicide. Males comprised 64% of decedents. Average age was 56.3 years. Factors, circumstances, and trends related to psychologist suicides are presented. In 2018, psychologist suicide deaths were estimated to account for 4.9% of suicides among 10 selected health professions. As the NVDRS expands to include data from all 50 states, it will become increasingly valuable in delineating the epidemiology of suicide for psychologists and other health professionals and designing prevention strategies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What are the experiences of clinical psychologists working with people with intellectual disabilities during the COVID-19 pandemic?

BACKGROUND

People with intellectual disabilities are a particularly vulnerable group, at an increased risk of mortality from COVID-19 and of poor mental health. Psychologists providing mental health support to people with intellectual disabilities report poorer mental wellbeing and higher occupational stress. Moreover, they raise concerns about the ability of people with intellectual disabilities to engage with digital technologies for mental health support in the context of reduced face-to-face psychological provision.

AIMS

The study aimed to understand psychologists' experiences of working with people with intellectual disabilities during the pandemic.

MATERIALS & METHODS

Semi-structured interviews were conducted with 11 psychologists from community intellectual disabilities services. Data were analysed using interpretative phenomenological analysis.

RESULTS

Two superordinate themes emerged. Survive or Thrive highlighted the challenges and successes clinical psychologists experienced while working during the pandemic. 'Left to Their Own Devices' described psychologists' experiences of their clients as forgotten within society.

CONCLUSION

The current study demonstrates psychologists' ability to adapt to extremely challenging circumstances, exposes the vulnerabilities of people with intellectual disabilities and highlights the gaps in service provision.

[The clinical practice of the psychologist in intensive care]

The intensive care psychologist was strongly mobilised during the COVID-19 health crisis. His clinical practice is both specific, with regard to the situations of extreme suffering that he is led to encounter, but also plural, as he is faced with the intersecting vulnerabilities of patients, families and carers.

Mental Health Interest and Its Prediction during the COVID-19 Pandemic Using Google Trends

This study aimed to analyze and predict interest in mental health-related queries created in Google Trends (GT) during the COVID-19 pandemic. The Google Trends tool collected data on the Google search engine interest and provided real-time surveillance. Five key phrases: “depression”, “insomnia”, ”loneliness”, “psychologist”, and “psychiatrist”, were studied for the period from 25 September 2016 to 19 September 2021. The predictions for the upcoming trend were carried out for the period from September 2021 to September 2023 and were estimated by a hybrid five-component model. The results show a decrease of interest in the search queries “depression” and “loneliness” by 15.3% and 7.2%, respectively. Compared to the period under review, an increase of 5.2% in “insomnia” expression and 8.4% in the “psychiatrist” phrase were predicted. The expression “psychologist” is expected to show an almost unchanged interest. The upcoming changes in the expressions connected with mental health might be explained by vaccination and the gradual removal of social distancing rules. Finally, the analysis of GT can provide a timely insight into the mental health interest of a population and give a forecast for a short period trend.

Differences Between the Psychological Symptoms of Health Workers and General Community After the First Wave of the COVID-19 Outbreak in Spain

The coronavirus disease-2019 (COVID-19) has worsened the physical and mental health of the general population. Healthcare workers have a high risk of suffering a mental disorder after the first wave. In this way, psychologists, who deal with mental health issues and are considered as healthcare workers in many countries, are of interest in this context. The present study aimed to examine anxiety, depression, stress, and obsessions and compulsions across psychologists, healthcare professionals, and the general community. These variables were measured through the Depression, Anxiety, and Stress Scale (DASS-21), as well as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which are related to different sociodemographic variables. The study was carried out after the first wave in Spain through an online questionnaire. Structural equation modeling and a multigroup analysis were carried out across the groups and variables under study. The results suggested that; (i) healthcare workers and general community depicted similar results in anxiety and stress, as well as obsessions; (ii) the group of psychologists depicted better scores than the other groups under study; (iii) stress and anxiety did not predict compulsions in the group of psychologists; (iv) anxiety predicted obsessions for all the professions, while the relationship of this variable with stress was different for each group; and (v) invariance reached a full metric level.

Essential competences for psychologists in palliative cancer care teams

The study aim was to clarify the essential competencies for psychologists in palliative care teams. A nationwide, multicentre cross-sectional survey was conducted. A 32-item questionnaire assessing endorsement of potential competencies was completed by 70 patients and/or families, 101 consulting personnel, 747 members of palliative care teams and 203 mental health providers. All 32 competencies were judged as essential. Of the 32 items, 9 and 28 items were endorsed by >95% and 80% of participants, respectively. The most frequently endorsed essential competency was ability to coordinate with other professionals in palliative care teams. Some competencies considered essential seemed specific to oncology and medical settings. The results suggest the need for specific guidance for psychologists working in palliative care teams and the development of clinical oncology training programmes and/or systems for psychologists.

Looking after each other in a crisis-Lessons from Novichok and the parallels with Covid-19

BACKGROUND

In March 2018, three patients were admitted to the Emergency Department of a District General Hospital. Originally suspected of having suffered an opiate overdose, it became clear that they were the victims of anti-cholinesterase poisoning-the Soviet era poison Novichok. Twenty-five days later, two further patients were admitted with the same symptoms. One of these patients died 8 days later and the second remained in hospital for 3 weeks. A Clinical Psychologist was present on the unit throughout the major incident and all staff directly involved received psycho-educational support regarding self-care.

AIMS

To examine the psychological impact of the longest running major incident in NHS history on the staff directly involved.

DESIGN

A cross-sectional design was used, with structured questionnaires administered retrospectively.

METHODS

A link to an electronic survey was emailed to every member of staff in the organization. The survey included the Hospital Anxiety and Depression Scale, the Maslach Burnout Inventory, the Impact of Events Scale-Revised (to both the March and June events).

RESULTS

540/4000 hospital staff responded (13.5% response rate) with a 29/59 (49%) response rate in intensive care staff. Frontline staff had significantly lower scores on anxiety (P < .05 for the June incident), depressive symptoms (P < .05 March and June) and subscales of burnout than managers (depersonalization P < .05). On the remaining two burnout subscales and on anxiety scores for those involved in March, results trended towards significance (P < .1).

CONCLUSIONS

Staff in management roles during major incidents may experience higher levels of psychological distress than staff in front line clinical roles and should be encouraged to seek psychological support.

RELEVANCE TO CLINICAL PRACTICE

This article informs teams of the psychological impact of major incidents on staff in intensive care settings.

Psychologist homicide victims: The National Violent Death Reporting System and other sources

OBJECTIVE

Homicide of healthcare workers has been reported but little is known about psychologists as victims of homicide. This study aimed to investigate what is known about homicide of psychologists.

METHODS

The Centers for Disease Control and Prevention's National Center for Injury Prevention and Control's National Violent Death Reporting System (NVDRS) provides insights into violent deaths, including homicide. This study interrogated the NVDRS and conducted Internet searches about psychologist decedents of homicide.

RESULTS

Between 2003 and 2018 the NVDRS identified 12 psychologist homicides. Internet searches revealed 15 psychologist homicides. Only three (11.1%) were known to have been killed by current or former patients. Another was by a colleague's patient. Another assailant was suspected to be a patient. We summarize patterns and circumstances of deaths, address issues related to violence in healthcare, and review selected resources addressing violence prevention.

CONCLUSION

Psychologists, like other health professionals, may be victims of homicide. Such deaths have diverse contributing factors and are rarely perpetrated by patients. As concern about health professional safety mounts and the NVDRS becomes better established, it will hopefully become a more sensitive, precise, comprehensive and useful mechanism for tracking trends in violent deaths of psychologists and other health professionals and ultimately inform preventative strategies.

Working with people experiencing psychotic disorders and co-occurring nicotine dependence: Attitudes and reflections from psychologists on the Healthy Lifestyles research trial

The combination of psychotic and substance use disorders compounds the well-documented challenges of treatment engagement, retention, and outcome for these single conditions. This study focuses on the formation of alliance among this important clinical group. Psychologists working on a research trial participated in qualitative interviews focused on their impression of delivering treatment to people with psychotic disorders and concurrent nicotine dependence. Utilizing Interpretive Phenomenological Analysis, the authors highlighted the complex and unusual experience of working with people with psychotic disorders and concurrent nicotine dependence, the importance of considering each client as an individual, and the many layers of interaction between therapist and client. The authors found that meaningful therapeutic relationships over the longer term are possible, even when active symptoms are present. There is also potential for telephone-based treatments to work well. Clinical supervision and support, tailored to the unique experience of therapists working with psychotic populations, is pivotal.

[Psychic issues and problems in allogeneic hematopoietic stem cell transplantation in pediatric]

In pediatric oncohematology, a hematopoietic stem cell transplant (HSC) may be offered depending on the pathology and the therapeutic objective. The transplant generates many repercussions, in particular related to the donation and the debt, on the physical and psychological identity of the donor and the recipient, with family changes. The multidisciplinary support of the families is essential so that everyone may find his right place.

The Human Side of COVID-19

The COVID-19 pandemic has had, and continues to have, a broad, deep, and pervasive impact on our lives, our work, and how our justice system functions. While it is easy to contemplate the "system" as a massive behemoth that is impervious, impersonal, and impenetrable, the truth is that the "system" is made up of people. The men and women whose work is the building blocks of the justice system are individuals, each with their own narrative, experience, perspective, and role in the administration of justice. To understand the system and the impact of COVID-19, it is essential to understand the stories of those who work in the system. This article presents the individual and human stories of four professionals whose professional lives are a part of the justice system. Each of these professionals tells their personal story of COVID-19 and reflects on how the pandemic affected them and their approach to the work that they do.

[Dialysis at home, from my place to ours]

The patient being cared for at home should be considered with his entourage. In the case of dialysis, the relative is involved and his relationship with the patient becomes more complex, because the patient is in a situation of increased dependency. Hence, the relative is a fully-fledged partner in home haemodialysis, particularly in the decision-making process. Support from professionals helps to rebalance this relationship, if necessary.

A theory-based examination of self-care behaviours among psychologists

The present study examined psychological, spiritual, physical/leisure and social self-care behaviours among psychologists using a major model of predicting human behaviour, the theory of planned behaviour (TPB). The study used a mixed method approach with two stages of data collection. Psychologists (N = 200) completed an online questionnaire assessing TPB constructs (attitude, subjective norm, perceived behavioural control and intention) and additional constructs of action planning, coping planning, peer and supervisor norms and organizational climate. Two weeks later, participants (n = 110) completed a follow-up questionnaire assessing their self-care behaviour. Results indicated general support for the standard TPB constructs in predicting self-care intentions for psychologists and the additional construct of action planning mediated the intention-behaviour relationship across most self-care dimensions. Findings from the current research provide further understanding of the factors influencing self-care engagement among psychologists and can be used to inform development of strategies to foster greater engagement in self-care behaviour.

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Illness and grieving the loss of a healthy body. Grief is a phenomenon which is part of the normal and the pathological. In the case of illness, it is felt for a body which is lost, different, becoming something other. This article studies the notions of grief, body schema and body image.

Delivering developmentally appropriate health care: Roles for psychologists as members of the multi-disciplinary health care team

There is increasing global attention on the health and wellbeing needs of young people. Preventive and proactive approaches will likely lead to the clearest dividends for young people, their own children and wider society. A brief overview of the international context for young people's health care is given. As well as influencing policy, there are important roles for the health care team, including psychologists, to influence the organisations they work within, advocating for the needs of young people and their families. This is the focus of this article. The concept of developmentally appropriate health care (DAH) for young people is explored. It could help when planning services and approaches that respond to the needs of young people. Building relationships is likely to be key, to connect with young people to help them make health and wellbeing decisions, and provide individualised support. The 'connectedness' research could also be helpful in looking beyond the health care evidence. A key challenge for psychologists and their multi-disciplinary health care colleagues, in practice and research, is to move away from a reliance on binary, easier-to-measure health and wellbeing outcomes and, instead, find ways to promote and measure developmental outcomes that are meaningful to young people and their families.

[Listening to physical suffering]

The psychologist's perspective on the issue of pain opens the way to new issues. One of the psychologist's roles in chronic pain consultations is to allow a psychological elaboration of the painful complaint. It seems essential for the carers, whatever their specialities, to move away from a dualistic "body-mind" concept, so as not to undermine the reception of this complaint, with its multiple interactions.

"Life Starts for Me Again." The Social Impact of Psychology on Programs for Homeless People: Solidarity Networks for the Effectiveness of Interventions

The role of psychology in the improvement of people’s lives is consistent, according to the scientific literature review. More and more studies within psychology, and other social sciences, are pointing out the importance of the quality of social interactions on physical and mental health and upon perceived wellbeing. When talking about homelessness, psychology has served these individuals mostly by informing intervention programs related to preventing and responding to substance abuse, healthcare, sexual risks, or mental illnesses, and these are key problems that psychology has also studied and found to be connected to homelessness. Such strategies, which were traditionally mostly centered on tackling the weaknesses that homeless people face, are now increasingly considering the role of the social support services. The aim of this study was, on the one hand, to identify evidence on the importance of solidarity as a key factor in the process of overcoming homelessness, and associated substance abuse situations, and the barriers and conditions to achieve it. On another hand, the aim was also to approach the impact of that solidarity on their general wellbeing from the perspective of homeless subjects themselves. To achieve this aim, 20 life stories of people aged 35 to 70 years old were conducted in the metropolitan area of Barcelona. The people interviewed had been homeless in a recent period of their lives and were currently dependent on different services. The communicative methodology allowed deepening into the life stories of these individuals via egalitarian dialogue between the researchers and the participants. The results of the qualitative analysis showed that a strong solidarity network was crucial in the process of overcoming the participants’ homelessness situation and to tackle related circumstances (alcoholism and drug abuse among others), and this has had an impact in their general wellbeing and in the development of more solidarity attitudes. These findings are discussed in light of psychological knowledge and other social sciences literature on the importance of quality social environments to support positive developmental trajectories and considering the potential social impact of the intervention programs that take into account the factor of solidarity during their implementation process.

Racial/ethnic differences in treatment quality among youth with primary care provider-initiated versus mental health specialist-initiated care for major depressive disorders

OBJECTIVES

To compare the racial/ethnic differences in treatment quality among youth with primary care provider-initiated versus mental health specialist-initiated care for major depressive disorders (MDD).

METHODS

A retrospective cohort study was conducted using the 2005-2007 Medicaid claims data from Texas. Youth aged 10-20 during the study period were identified if they had two consecutive MDD diagnoses and received either medications for MDD or psychotherapy. Patients who received ≥84 days of medications and/or ≥4 sessions of psychotherapy for MDD treatment during 4 months of follow-up were considered meeting the minimum adequacy of treatment.

RESULTS

The generalized linear multilevel model (MLM) analysis revealed that both Hispanics and Blacks were approximately 30% less likely to receive adequate treatment (Hispanics - OR: 0.67; 95% CI: 0.6-0.8) (Blacks - OR: 0.66; 95% CI: 0.6-0.8) and Hispanic children were 50% more likely to undergo MH-related hospitalization (OR: 1.53; 95% CI: 1.1-2.2) compared to their White counterparts. The odds of meeting the minimum MDD treatment adequacy were comparable between pediatric MDD cases first identified by primary care providers (PCP-I) and psychiatrists (PSY-I) (PCP-I vs. PSY-I: OR: 0.97; 95% CI: 0.8-1.2), and slightly lower in those first identified by social workers/psychologists (SWP-I) as compared to PSY-I (SWP-I vs. PSY-I: OR: 0.81; 95% CI: 0.7-0.9). In all models, the interaction between race/ethnicity and type of provider who initiated MDD care was not statistically significant.

CONCLUSIONS

Minority youths received less adequate MDD treatment compared to Whites. Hispanic children had the highest risk of having mental health-related hospitalization. The specialty of provider who initiated MDD care had limited impact on treatment quality and was not associated with the racial/ethnic variations in treatment completion and mental health-related hospitalizations.

[Characteristics and prevention of burnout syndrome among nurses]

Within the health care system, nurses face multiple hazards from the aspect of burnout syndrome (emotional exhaustion, depersonalisation, and reduced personal accomplishment) development. Burnout has a negative impact on the health and economic status of individuals. Moreover, burnout diminishes compliance, reduces the quality of care, and it influences the prevalence of medical malpractice and complications. Therefore the identification, prevention and treatment of burnout are of public interest. In this study, we present the occurrence of burnout among Hungarian nurses, and we recommend options to prevent the burnout of nurses, focusing especially on the role and possibilities of psychological counselling. All these provide practical aspects and feasibility in preventing and overcoming burnout. Orv Hetil. 2019; 160(1): 12-19.

Psychological reports for sentencing juveniles in Australian courts

Psychological reports for use in court must be relevant to the legal issues in dispute, meet professional standards, and reflect evidence-based practice. Using the Delphi method, a high degree of consensus was found among Australian experts in the methodology and knowledge required for conducting forensic mental health assessment (FMHAs) and the content needed in pre-sentence reports. Consensus was absent in two areas, if a pre-sentence report should always include a risk-assessment; and the need for a model to guide the FMHA. Without a model it is difficult for practitioners to justify their decision-making process, and judicial officers have no mechanism to determine if the work provided to the court is of an acceptable standard. Future research should focus on developing a model for presentence reports that includes a decision-making process and minimum standards. Researchers also need to determine judicial officers' views on the helpfulness of presentence reports.

[Restraint in nursing homes, the psychologist's point of view]

With regard to restraint, the caregiving teams are confronted on a daily basis with various issues which reveal a clash between the respect of a person's rights and dignity and the need to protect and provide a safe environment. The triangular relationship between the resident, their family and the multidisciplinary caregiving team can result in the construction of a response to this dilemma between liberty and safety.

[Clinical approach to stress in occupational psychopathology]

In the workplace, everyone is aware of the constraints of an organisation, but often, work related stress is refuted. However, the employer must take the necessary measures to ensure its employees' safety. Occupational psychopathology consultations constitute a resource for supporting people with stress and carrying out preventive actions.

[The psychologist in paediatric intensive care, liaison and separation]

The relationship between the interventions of liaison psychiatry and those of general medicine is essential. The psychologist, notably, plays an important role in a paediatric intensive care unit. A double temporality, somatic and psychological, is to be taken into account in order to hear, beyond the individual, what the subjet has to say.

Influence of preoperative information support on anxiety, pain and satisfaction with postoperative analgesia in children and adolescents after thoracic surgery: A randomized double blind study

AIMS/BACKGROUND

The proportion of patients who experience anxiety prior to planned surgery, even a minimally invasive one, is estimated at 50-70%. Thoracic surgery, causes significant preoperative anxiety, especially in children. The aim of this study was to determine the effect of an important component of psychological preparation for a surgery as information support on levels of anxiety, pain and satisfaction with postoperative analgesia.

METHODS

The randomized double blind study including patients aged 9-18 years qualified for lateral thoracotomy or Ravitch procedure. The subjects were randomized to the control group (n=56) provided with a routine preoperative information by a nurse, and the experimental group (n=56) offered additional psychological consultation. Data were collected via the State-Trait Anxiety Inventory.

RESULTS

In the experimental group, the level of state anxiety at 48 h post-surgery was significantly lower than prior to the procedure, but only in subjects with preoperative trait anxiety Conclusion: Information support from a psychologist offered prior to a thoracic surgery decrease the level of postoperative state anxiety solely in children with lower levels of trait anxiety. Higher level of postoperative state anxiety negatively affect patients' satisfaction with post-surgical analgesia.

TRIAL REGISTRATION

ClinicalTrials.gov; Influence of Preoperative Support on Anxiety, Pain and Satisfaction With Postoperative Analgesia; NCT03488459, https://clinicaltrials.gov/ct2/show/record/NCT03488459?cntry=PL&city=Rabka-Zdr%C3%B3j&rank=1.

The development of a template for psychological assessment of women considering risk-reducing or contralateral prophylactic mastectomy: A national Delphi consensus study

OBJECTIVE

Risk-reducing mastectomies (RRM) and contralateral prophylactic mastectomies (CPM) are increasingly prevalent strategies to reduce breast cancer risk. Given the associated physical and emotional challenges, presurgical psychological assessment is frequently recommended for this population, yet limited research exists to guide this. This study aimed to reach a consensus on the most relevant content and format of a psychological consultation prior to RRM/CPM.

METHODS

A modified two-round online Delphi study was conducted Australia-wide. Expert participants (n = 25), including psychologists, surgeons, nurses, oncologists, genetic specialists, and researchers completed a round-one survey, informed by a literature review, previous qualitative study and expert clinicians' input. This required participants to rate their agreement with 36 statements regarding potential content of a psychological consultation and provide feedback on format/structure. A round-two survey comprised items that had not reached consensus and six new items suggested by participants. Parameters for statement consensus were set a priori at >75% agreement.

RESULTS

Expert participants indicated agreement with the majority of statements (39/42, 92.8%), endorsing that the assessment should include (1) patient understanding of the RRM/CPM procedure/cancer risk, (2) potential physical/emotional impact of surgery, (3) informed decision-making, and (4) past/current psychological issues (anxiety and body image). A provisional assessment template and user manual is provided.

CONCLUSIONS

This research culminated in a consensus-based template to guide psychological assessment of women considering RRM/CPM. This enables health professionals to assess suitability for surgery and preempt challenges within a standardised framework. Future evaluation of the acceptability and effectiveness of the template in clinical settings is warranted.

[Caring for those who care for us]

The AAPML is a French association offering support for health professionals and private practice doctors suffering from stress via a helpline. It provides information and training for health professionals and takes into account their engagement in the workplace.

[The TPE nurse improving the patient's quality of life]

The impact of interventions by therapeutic education nurses on compliance and the quality of life of patients with chronic diseases has been proven. These different perspectives of caregivers and patients highlight the specific case of the treatment of HIV.