Spiritual well-being of people with psychiatric disabilities: the role of religious attendance, social network size and sense of control

The influence of psychiatric symptoms, religious attendance, social network size, and sense of control on spiritual well-being were investigated in a cross-sectional study using the Spirituality Index of Well-being. Forty-seven participants with psychiatric disabilities from six consumer-run organizations participated. A factor analysis result revealed two domains of spiritual well-being for people with psychiatric disabilities: self-perceptions regarding making sense of life (developing life purpose) and self-efficacy in obtaining life goals. Based on our regression analyses, religious attendance, expanding social network size, and having a sense of control over important areas of life may enhance spiritual well-being in spite of severity of psychiatric symptoms. Supporting mental health consumers who hope to be fully integrated into social and spiritual communities is important. Given the increased attention to consumers’ internal spiritual experiences in a recovery process, this study adds to knowledge about spirituality in the mental health field.     

Predisposing,Enabling, and Need Factors Associated with High Service Use in a Public Mental Health System

The purpose of this study was twofold: (1) To investigate the individual- and system-level characteristics associated with high utilization of acute mental health services according to a widely-used theory of service use—Andersen’s Behavioral Model of Health Service Use —in individuals enrolled in a large, public-funded mental health system; and (2) To document service utilization by high use consumers prior to a transformation of the service delivery system. We analyzed data from 10,128 individuals receiving care in a large public mental health system from fiscal years 2000–2004. Subjects with information in the database for the index year (fiscal year 2000–2001) and all of the following 3 years were included in this study. Using logistic regression, we identified predisposing, enabling, and need characteristics associated with being categorized as a single-year high use consumer (HU: >3 acute care episodes in a single year) or multiple-year HU (>3 acute care episodes in more than 1 year). Thirteen percent of the sample met the criteria for being a single-year HU and an additional 8% met the definition for multiple-year HU. Although some predisposing factors were significantly associated with an increased likelihood of being classified as a HU (younger age and female gender) relative to non-HUs, the characteristics with the strongest associations with the HU definition, when controlling for all other factors, were enabling and need factors. Homelessness was associated with 115% increase in the odds of ever being classified as a HU compared to those living independently or with family and others. Having insurance was associated with increased odds of being classified as a HU by about 19% relative to non-HUs. Attending four or more outpatient visits was an enabling factor that decreased the chances of being defined as a HU. Need factors, such as having a diagnosis of schizophrenia, bipolar disorder or other psychotic disorder or having a substance use disorder increased the likelihood of being categorized as a HU. Characteristics with the strongest association with heavy use of a public mental health system were enabling and need factors. Therefore, optimal use of public mental services may be achieved by developing and implementing interventions that address the issues of homelessness, insurance coverage, and substance use. This may be best achieved by the integration of mental health, intensive case management, and supportive housing, as well as other social services.     

Mental health problems among single and partnered mothers

Background Research has shown elevated levels of common mental disorders among single mothers compared with partnered mothers. The objectives of this analysis were to examine the prevalence of mental health problems among single and partnered mothers and the extent to which this relationship is mediated by socio-demographic, financial and social support variables. Methods Using cross-sectional data from a large, nationally representative longitudinal Australian household survey—the Household Income and Labour Dynamics in Australia (HILDA) Survey—the prevalence of moderate to severe mental disability (as measured by the SF-36) was assessed among 354 single mothers and 1,689 partnered mothers. A series of univariate and simultaneous logistic regression analyses assessed the association between parenting status, the other explanatory variables and mental disability. Mediational analyses were conducted using the ‘explained fraction’ approach. Results The prevalence of moderate to severe mental disability was significantly more pronounced among single mothers (28.7%) compared with partnered mothers (15.7%). Including all explanatory factors—socio-demographic, household income, financial hardship and social support—accounted for 94% of the association between single mother status and poor mental health. Financial hardship and social support were the strongest predictors, accounting for most of the predictive power of the other variables. Conclusions Single mothers are more likely to experience poor mental health than partnered mothers, and the primary factors associated with this are the presence of financial hardship in particular, as well as perceived lack of social support. Future research should examine the extent to which changes in financial hardship among different family types relate to changes in mental health over time, as well as continue to examine variables that may moderate the relationship between social disadvantage and poor mental health.     

Demands,control, supportive relationships and well-being amongst British mental health workers

Purpose  

Staff well-being is considered to be a potential problem within mental health occupations, and its variability is in need of investigation. Our starting point is to assess the role of demands, control and supportive relationships that are at the core of Karasek’s model. The study aims to assess the relationship amongst mental health workers of job demands, control and support (from peers and superiors) with multiple measures of well-being.     

Consumer Perspectives on Information and Other Inputs to Decision-Making: Implications for Evidence-Based Practice

This study is an exploration of mental health consumers’ perspectives on information, including scientific information, and on other inputs to decision-making. Four focus groups were held with severely mentally ill consumers at two sites in the summer of 2005. Consumers varied in age, race and diagnosis. Participant responses were coded by theme and into subthematic categories. Implications for evidence-based decision-making included that: consumers desire and seek information about their illnesses and the mental health system; consumers identify scientific studies as information with special and welcome properties; and consumers also identify other influences on their decision-making, most of which fall under the “recovery” rubric.     

Worry,Severity, Controllability,and Preventive Behaviours of COVID-19 and Their Associations with Mental Health of Turkish Healthcare Workers Working at a Pandemic Hospital

Previous research suggests that psychological and behavioural factors such as worry, severity, controllability, and preventive behaviours are associated with mental health and well-being. Less is known about simultaneous effects of those factors in predicting mental health and well-being. This study aimed to present the prevalence of mental health problems and identify the predictors of mental health and subjective well-being of healthcare workers during the COVID-19 pandemic. Participants included 245 healthcare workers (M_age?=?33.16?±?7.33; 50.61% females) from a pandemic hospital in Turkey. Healthcare workers reported mild/severe depression, anxiety, and stress. Females tended to be more vulnerable to developing psychiatric symptoms. Worry, severity, and controllability significantly predicted depression, anxiety, stress, and subjective well-being while preventive behaviours only predicted subjective well-being. These findings suggest the importance of assessing healthcare workers’ experiences of mental health and subjective well-being and their associated factors to assist mental health providers tailor assessments and treatment during a pandemic.

     

Revisiting Practice-Based Research Networks as a Platform for Mental Health Services Research

Practice-based research networks (PBRNs)—collaborations of practice settings that work together to generate research knowledge—are underused in mental health services research. This article proposes an agenda for mental health services research that uses a variety of PBRN structures and that focuses on what really happens in practice, the effectiveness of practice innovations in real world care, the challenges of implementing evidence supported interventions, modification of clinician behavior, and assessment of the effect of mental health policy changes on practice. The challenges of conducting research within PBRNs are substantial, including difficulties in maintaining positive member relations, securing ongoing funding, sustaining productivity, overcoming IRB entanglements and achieving both scientific excellence in recruitment and measurement validity and utility for practitioner members. However, the awareness of these challenges allows researchers and practitioners to build networks that creatively overcome them and that infuse mental health services research with heavy doses of the realities of everyday clinical practice.     

Relevance of well-being,resilience, and health-related quality of life to mental health profiles of European adolescents: results from a cross-sectional analysis of the school-based multinational UPRIGHT project

Purpose

The existing evidence suggests that a complete evaluation of mental health should incorporate both psychopathology and mental well-being indicators. However, few studies categorize European adolescents into subgroups based on such complete mental health data. This study used the data on mental well-being and symptoms of mental and behavioral disorders to explore the mental health profiles of adolescents in Europe.

Methods

Data collected from adolescents (N = 3767; mean age 12.4 [SD = 0.9]) from five European countries supplied the information on their mental well-being (personal resilience, school resilience, quality of life, and mental well-being) and mental and behavioral disorder symptoms (anxiety, depression, stress, bullying, cyber-bullying, and use of tobacco, alcohol, or cannabis). Multiple correspondence analysis and cluster analysis were combined to classify the youths into mental health profiles.

Results

Adolescents were categorized into three mental health profiles. The "poor mental health" profile (6%) was characterized by low levels of well-being and moderate symptoms of mental disorders. The "good mental health" profile group (26%) showed high well-being and few symptoms of mental disorders, and the "intermediate mental health" profile (68%) was characterized by average well-being and mild-to-moderate symptoms of mental disorders. Groups with higher levels of well-being and fewer symptoms of mental disorders showed lower rates of behavioral problems. Mental well-being indicators strongly contributed to this classification.

Conclusion

Adolescents with the "intermediate" or "poor" mental health profiles may benefit from interventions to improve mental health. Implications for school-based interventions are discussed.

Trial registration number (TRN) and date of registration

ClinicalTrials.gov Identifier: NCT03951376. Registered 15 May 2019.

     

Mobile Applications for Mental Health Providers

Mobile devices such as smartphones and tablets have fundamentally changed the ways in which we interact with information. Far more than communication devices, smartphones and tablets are now indispensable tools in the pocket of healthcare providers. Mobile mental health applications (apps) provide instant access to up-to-date information on prevention, assessment and treatment. Self-help apps allow patients to take greater ownership of their own health and well-being. The past decade has seen an extraordinarily rapid proliferation of mobile medical apps. Though thousands of apps now exist, the challenge for healthcare providers and consumers alike has become sorting through mobile apps for those which provide accurate content delivered in the most user-friendly format. This article will review six mobile apps that can assist healthcare providers and consumers interested in enhancing mental health.     

Predictors of Referral to Supported Employment Among Consumers with Co-Occurring Mental and Substance Use Disorders

Clinical trials demonstrate that Supported Employment is effective in assisting persons with severe mental illness in obtaining competitive employment. However, little is known about the factors related to consumers’ decisions to pursue employment, especially for consumers with co-occurring substance and mental disorders. This study examines the demographic, socioeconomic and illness characteristics of consumers referred for Supported Employment services. Consumers were drawn from Integrated Dual Diagnosis Treatment programs in four community mental health agencies. Study participants included 113 consumers referred for Supported Employment services and 78 randomly selected non-referred consumers as the comparison group. Results suggest that consumers who have past work experience are more likely to be referred to Supported Employment, while consumers who perceive themselves as disabled or who are diagnosed as substance dependent are less likely to be referred to Supported Employment. Implications for agency practice and future research are discussed.     

Telepsychiatry and geriatric care

The use of telecommunications—telephone, computer, videoconferencing equipment—to provide mental health services at a distance has grown rapidly. This review encompasses reports from programs that provide telepsychiatry services, including telephone- and computer-based education and support services, telephone screening for dementia, and the use of videoconferencing to provide psychiatric consultations, health education, and administrative support. The extensive experience to date supports the value of telepsychiatry. Applications in geriatric settings and research involving geriatric subjects are reviewed. Cost analyses and economic evaluations of telepsychiatry are preliminary at this time and need further refinement. There is great potential for using telecommunications to expand access to mental health services to underserved geriatric populations.     

The Relationship Between Consumer Insight and Provider-Consumer Agreement Regarding Consumer’s Quality of Life

This study examined the relationship between insight and mental health consumers and providers agreement regarding consumers rated quality of life (QoL). Seventy mental health consumers and their 23 care providers filled-out parallel questionnaires designed to measure consumer QoL. Consumers’ insight was also assessed. For most QoL domains, agreement between consumers and providers was higher for persons with high insight. For the Psychological well being dimension a negative correlation was uncovered for persons with low insight indicating disagreement between consumer and provider. These findings are discussed within the context of the literature on insight and agreement between consumer and provider as related to the therapeutic alliance.     

Suicide rates, life satisfaction and happiness as markers for population mental health

Objective To examine the association of variables from survey data on well-being with suicide rates and other markers of population mental health in Europe. Design Ecological study correlating (Spearman’s rank correlation) life satisfaction and happiness (European Values Survey 1999/2000) in 32 countries with suicide rates (WHO Mortality Database), rates of hospital discharge for mental and behavioural disorders and prevalence of mental disorders based on registered mental patients (WHO Regional Office for Europe) and Mental Health Index (MHI)-5 survey data (European Opinion Research Group). Results An inverse association exists between suicide rates and life satisfaction (r=−0.44; 95% CI: −0.68, −0.11) and happiness (r=−0.42; 95% CI: −0.67, −0.08). Similar though weaker associations were seen with hospital discharge data and MHI−5 data but not with the prevalence of mental disorders. The association between suicide rates and life satisfaction was weaker amongst 15–44 year olds (r=−0.31; 95% CI: −0.59, 0.04) than amongst 45–64 year olds (r=−0.47; 95% CI: −0.70, −0.14). It was strongest in the 65+ age group (r=−0.54; 95% CI: −0.75, −0.23). A similar pattern was observed for the association with happiness. In a subgroup analysis, the association between suicide and life satisfaction in Eastern Europe was similar to that in the whole dataset (r=−0.35) but a positive association was seen in Western Europe (r=0.47). Conclusions Life satisfaction and happiness were modestly associated with other indicators of population mental health. Since all such markers have their limitations, surveys of well-being may be useful indicators of population mental health.     

Determinants of Positive Mental Health in Adolescents–A Cross-Sectional Study on Relationships between Positive Mental Health,Self-Esteem,Character Strengths and Social Inclusion

Adolescence is a crucial time period with especial vulnerability for development of mental health problems. Growing interest is focusing on the determinants of positive mental health in order to find the key concepts that could be influenced in the promotion of mental well-being of adolescents. In this study we aim to explore the relations between self-esteem, character strengths and experience of social inclusion as determinants of adolescents’ positive mental health controlled for selected sociodemographic background factors. The study population (n = 195) consisted of comprehensive school students who filled in an electronic questionnaire of adolescent’s mental well-being in Fall 2019. The questionnaire included measures of Warwick-Edinburgh Mental Well-being Scale (WEMWBS), VIA Youth-measure 96, Rosenberg Self-Esteem Scale and Experience of Social Inclusion Scale. The methods included group comparisons and General Linear Model computed by SPSS 24.0. The strongest association was found between positive mental health and self-esteem (β = 0.789, p < 0.001), followed by character strengths of hope and kindness and experience of social inclusion. Interestingly, family’s socioeconomic factors did not associate significantly with positive mental health in the final statistical model. In terms of our results, it seems that self-esteem, character strengths and experience of social inclusion might have stronger association with adolescents’ mental well-being than family’s socioeconomic determinants. Therefore, it should be discussed whether psychological determinants overcome the individual effect of poor socioeconomic status as factors that influence positive mental health. Further studies are needed to establish these results more firmly.     

Battling in the Trenches: Case Managers’ Ability to Combat the Effects of Mental Illness Stigma on Consumers’ Perceived Quality of Life

Intervention effectiveness research requires that investigators include “real world” variables in the design of studies to develop an understanding of how interventions perform in the “real world.” Two areas that have been neglected in effectiveness research on mental health case management are mental illness self-stigma and the effects of different case managers. Self-stigma is a reality for many consumers that negatively impacts their lives. Case managers, themselves, are a potential source of autocorrelation and likely provide services differently. This study explores the relationship between self-stigma and quality of life for consumers receiving services from different case managers. Cross-sectional data were collected from 160 consumers of an urban case management agency. Self-stigma was negatively associated with quality of life. Case managers did not account for a significant amount of variance in quality of life scores. However, the interaction between case manager and self-stigma was significant. Some case managers were able to mitigate the negative effects of self-stigma on quality of life. Future effectiveness research in community mental health case management needs to account for the effects of self-stigma, case managers, and the interaction between the two in the research design.     

Discrimination,Perceived Social Inequity,and Mental Health Among Rural-to-Urban Migrants in China

Status-based discrimination and inequity have been associated with the process of migration, especially with economics-driven internal migration. However, their association with mental health among economy-driven internal migrants in developing countries is rarely assessed. This study examines discriminatory experiences and perceived social inequity in relation to mental health status among rural-to-urban migrants in China. Cross-sectional data were collected from 1,006 rural-to-urban migrants in 2004–2005 in Beijing, China. Participants reported their perceptions and experiences of being discriminated in daily life in urban destination and perceived social inequity. Mental health was measured using the symptom checklist-90 (SCL-90). Multivariate analyses using general linear model were performed to test the effect of discriminatory experience and perceived social inequity on mental health. Experience of discrimination was positively associated with male gender, being married at least once, poorer health status, shorter duration of migration, and middle range of personal income. Likewise, perceived social inequity was associated with poorer health status, higher education attainment, and lower personal income. Multivariate analyses indicate that both experience of discrimination and perceived social inequity were strongly associated with mental health problems of rural-to-urban migrants. Experience of discrimination in daily life and perceived social inequity have a significant influence on mental health among rural-to-urban migrants. The findings underscore the needs to reduce public or societal discrimination against rural-to-urban migrants, to eliminate structural barriers (i.e., dual household registrations) for migrants to fully benefit from the urban economic development, and to create a positive atmosphere to improve migrant’s psychological well-being.     

The Kansas Consumer as Provider program: measuring the effects of a supported education initiative

Consumers providing direct services at mental health centers contribute positive qualities to the service delivery system; however, there are few instructional programs to prepare consumers for these roles. Of the few consumer-provider training programs that exist, those conducting research have focused on employment and hospitalization outcomes. No program has researched changes in students' perceptions of subjective well-being. Research with students in the Kansas Consumer as Provider (CAP) training program found significant differences in students' perception of hope, self-esteem, and recovery after the training program.     

Referral to Consumer-run Programs by Mental Health Providers: A National Survey

This study describes mental health providers’ awareness of, attitudes toward, and likelihood to refer to consumer-run programs. A mail survey method was used with a total of 301 questionnaires returned (33.5% response rate) from a national random sample. Findings suggest that providers believe consumers are able to provide effective mental health services, yet have less confidence in consumer-run programs. Slightly over half of the providers were aware of consumer-run programs and fewer had made referrals. Providers in non-public settings, agencies that hire consumers as providers, and agencies that collaborate with consumer-run programs were more likely to have made referrals. To maximize available community supports for service recipients, providers should consider newer, consumer-run service technologies.     

Organizational and Individual Factors Affecting Consumer Outcomes of Care in Mental Health Services

The impact of organizational and individual factors on outcomes of care were assessed for 424 adult consumers with chronic mental illness who were receiving services from one of 14 Community Mental Health Organizations (CMHOs) in Colorado over a 30-month period, as part of a larger statewide evaluation of the impact of Medicaid capitation on mental health services. Data on organizational culture and climate were aggregated from surveys of staff and administrators conducted within CMHOs over a two-year period corresponding to the collection of consumer outcome and service utilization data. Growth curve analyses were conducted on consumer perceptions of physical and mental health, and on quality of life (QOL). Analyses indicated a significant cross-level effect of organizational culture and climate on improvements in consumer perceptions of physical and mental health, but not on a “quasi-objective” index of QOL. Individual characteristics, such as age, diagnosis, gender, and ethnicity, were significant predictors of outcomes. Being older, female, an ethnic minority, and having a diagnosis of schizophrenia all predicted poorer outcomes among consumers. These findings are discussed in terms of their implications for policy and future research.     

Community-based cross-cultural adaptation of mental health measures in emergency settings: validating the IES-R and HSCL-37A in Eastern Democratic Republic of Congo

Background  

This study aims at providing qualitative and quantitative evidence on the relevance of two broadly used mental health self-report measures—Impact of Event Scale Revised (IES-R) and Hopkins Symptom Checklist 37 for Adolescents (HSCL-37A)—for use in Eastern Democratic of Congo, as no psychological assessment instruments were available for this region. We therefore describe an apt procedure to adapt and translate standard screening instruments in close collaboration with the local community, feasible under challenging conditions in emergency settings.