Treatment with youth who have committed sexual offences: Extending the reach of systemic interventions through collaborative partnerships

Delivery of high‐quality mental health services to clients in regional and remote areas in Australia presents significant challenges. Griffith Youth Forensic Service (GYFS) provides specialised, state‐wide assessment and systemic treatment services for young people in Queensland who have committed sexual offences. In an effort to provide equitable, ecologically valid services, GYFS clinicians recruit local para/professionals as collaborative partners in interventions. The success of GYFS interventions relies partly on the skills, knowledge and confidence of collaborative partners to work effectively. This study examines (a) the effectiveness of collaborative partnerships in enhancing knowledge, skills and confidence, and (b) the perspectives of collaborative partners regarding the collaborative model. Participant self‐reports (n = 47 collaborative partners) indicated that skills, knowledge and confidence were significantly increased over the collaboration, were maintained for 1 year, and that increased knowledge, skills and confidence were associated with perceived improvements in client outcomes.     

Perceived effectiveness of mental health care provided by primary-care physicians and mental health specialists

The authors used data from the Canadian Community Health Survey: Mental Health and Well-Being to estimate and compare perceived effectiveness of mental health care provided by general practitioners/family doctors (GP/FDs), by mental health specialists among those who visited GP/FDs, and by mental health specialists-only in the past 12 months (N=2,859). The authors found that, in Canada, perceived effectiveness of mental health care provided by GP/FDs did not significantly differ from that provided by mental health specialists. Using services from both GP/FDs and mental health specialists and taking psychotropic medication improved perceived effectiveness of care.     

Randomized Trial of the Parent And Caregiver Active Participation Toolkit for Child Mental Health Treatment

The purpose of this pilot study was to examine preliminary feasibility, acceptability, and effectiveness of a toolkit (Parent And Caregiver Active Participation Toolkit) to increase parent participation in community-based child mental health services. Study participants included 29 therapists (93% female; M age = 34.1 years; 38% Latino) and 20 parent/child dyads (children 80% female; M age = 8.6 years; parents 40% Latino) in 6 diverse community mental health clinics. Therapists were randomly assigned to standard care or the toolkit with standard care. Therapist and parent survey data and observational coding of treatment sessions were utilized. Mean comparisons and repeated measures analyses were used to test differences between study conditions over 4 months. Results supported preliminary feasibility and acceptability of the toolkit, with therapists assigned to the toolkit participating in ongoing training, adhering to toolkit use, and perceiving the toolkit as feasible and acceptable within their setting. Results preliminarily demonstrated improvement in therapists’ job attitudes, as well as actual use of parent engagement strategies. Results also preliminarily demonstrated increases in parent participation in child therapy sessions and more regular attendance, as well as some indication of support for perceived treatment effectiveness. Overall, results suggest the feasibility, acceptability, and potential effectiveness of the toolkit to enhance therapist job attitudes; practices that support parent engagement, parent engagement itself, and consumer perspectives on treatment outcomes; and the potential promise of future research in the area of parent participation interventions in child mental health services.     

Predicting patient deterioration in youth mental health services: community mental health vs. managed care settings

Objective: To examine differences across a community mental health system and a private managed care system in the accuracy of a warning system designed to identify youth at risk for deterioration in mental health services. Design: Longitudinal outcome data from the Youth Outcome Questionnaire (Y‐OQ) were examined using multilevel modeling for 2,310 youth ages 4–17 who received outpatient treatment. Results: The warning system correctly identified 69% of cases that ultimately ended in deterioration in the community mental health setting, compared to 61% in the managed care setting. The overall hit rate (overall accuracy in classifying cases as deteriorators/non‐deteriorators) was the same in the two settings (75%). Conclusions: Results are consistent with previous research demonstrating that patient‐focused warning systems can be reasonably accurate in identifying youth cases at risk for treatment failure. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–17, 2011.     

Vitality, mental health, and satisfaction with information after breast cancer

OBJECTIVE: The purpose of this study was to investigate the relationship between satisfaction with information about treatment-related and survivorship issues and mental health outcomes, including vitality, in long-term breast cancer survivors. METHODS: Participants who had finished treatment for breast cancer at least 3 months before enrollment completed a survey instrument designed to evaluate satisfaction with diagnostic and treatment information and satisfaction with survivorship information. Mental health and vitality were measured using the Medical Outcomes Study SF-36, and distress was measured using the impact of events scale. Bivariate analyses and linear regression analyses were performed to investigate the relationships between satisfaction with information, mental health, vitality, and distress controlling for clinical and treatment variables. RESULTS: The survey was completed by 231 participants (response rate 83%). More respondents were highly satisfied with treatment information (87%) than with survivorship information (30%, p=0.0001). There was a strong positive relationship between satisfaction with information (both treatment and survivorship issues) and vitality, mental health, and a strong negative relationship with distress. In multivariate analyses, satisfaction with treatment information was independently associated with mental health (p<0.01), and satisfaction with survivorship information was independently associated with vitality (p<0.05). CONCLUSION: Among patients who have completed treatment for breast cancer, satisfaction with diagnosis and treatment information is greater than satisfaction with survivorship issues and satisfaction with information may play an important role in mental health outcomes. PRACTICE IMPLICATIONS: Given the relationship between satisfaction with information and vitality, interventions to improve informational support regarding survivorship issues are warranted.     

Mental health change in the transition to permanent supportive housing: The role of housing and social networks

Aims: Permanent Supportive Housing (PSH) may improve homeless adults’ mental health via housing stabilization and/or improved relational factors, however, the role of housing and social networks on PSH residents' mental health change is minimally understood. Methods: Interviews were conducted with a baseline sample of adults experiencing homelessness ( N = 421), across their initial year in PSH (3‐months, 6‐months, and 12‐months). Generalized linear mixed models assessed changes in positive past‐month psychiatric disability screenings (Modified‐Colorado Symptom Index [MCSI]) and probable posttraumatic stress disorder (PC‐PTSD) in controlled models, and between and within‐subject effects of time‐varying social network correlates on mental health changes. Results: Compared with baseline, positive MCSI screens continuously decreased over time (56%, 54%, and 50%) while PC‐PTSD screens declined initially (40%) with marginal decreases at remaining follow‐ups (39% and 38%). These differences remained significant in controlled models. Gaining a romantic partner was associated with a longitudinal increase in a positive MCSI screening. Between subjects, emotional health counselors and conflicting network members were associated with an increased likelihood in positive screenings, while doctors and case managers were protective. Conclusion: Housing may facilitate positive changes in PSH residents' mental health, yet positive screenings remain high. Social network interventions that increase residents’ positive interpersonal exchanges and prosocial relationships are warranted.     

Loneliness and social support: Differential predictive power on depression and satisfaction in senior citizens

The lack of social support and the feelings of loneliness among older adults are associated with physical and mental health negative outcomes. This study attempts to test for their differential predictive power on depression and satisfaction in seniors. Data were drawn from a sample of 335 older adults ranging from 55 to 80 years old, with a mean age of 63.97 years (standard deviation = 5.56) attending a learning program at the University of Valencia during the academic year 2014–2015. In addition to health and wellbeing outcomes, we used the Functional Social Support Questionnaire DUKE‐UNC, and two scales of loneliness, the de Jong Gierveld Loneliness Scale and the University of California Loneliness Scale version 3. Using structural equations models with Mplus, two models were proposed to assess the predictive power of social support and loneliness on wellbeing outcomes, specifically life satisfaction and depression, while controlling for health. Results confirm the negative association between loneliness and satisfaction with life and the positive one with depression.     

Older peoples' attitudes to mental illness

Despite the prevalence of mental health problems in later life, older people markedly underutilize mental health services. A greater awareness of factors influencing older peoples' attitudes to mental illness may therefore improve awareness and treatment of mental disorders in this population. A mixed methodology approach was used to explore and compare older peoples' attitudes to mental illness in a sample of clinical and non‐clinical participants. Results indicated that, similar to younger people, older people endorsed a range of positive and negative attitudes to mental illness. However, when attitudes to mental illness were considered within the context of ageing and experience a more complex pattern of results emerged. Although negative attitudes to mental illness were associated with negative attitudes to ageing across the entire sample, clinical participants (and those with prior experience of mental illness) reported more positive attitudes to mental illness and more negative attitudes to ageing than non‐clinical participants, for whom the reverse was true. Attitudes were also differentially related to health behaviour outcomes. Results suggest that attitudes to mental illness and ageing may be linked and mediated by personal experience and capacity for psychological self‐regulation in the face of age‐associated adversity. Copyright © 2009 John Wiley & Sons, Ltd.     

Help seeking and satisfaction among Latinas: The roles of setting,ethnic identity,and therapeutic alliance

This study explored help seeking among primary Spanish speaking women of Hispanic origin who had behavioral health needs. We evaluated relational and cultural aspects of care and service utilization by using qualitative and quantitative measures of perceived behavioral health needs, therapeutic relationships, ethnic identity and degree of acculturation, and satisfaction with services among 103 women. We explored the nature of the therapeutic relationship and satisfaction with services among Latinas who received behavioral health services at: (1) a community behavioral health center, (2) a community health center, and (3) a faith‐based agency. Overall, results demonstrated that participants had strong therapeutic alliances and were satisfied with services at the three different treatment sites. Differences noted, including clinical and research implications, are also described. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 299–312, 2005.     

Social Support, Health and Satisfaction among the Elderly with Chronic Conditions in Taiwan

This study examines possible relationships between perceived social support, physical and mental health, satisfaction towards hospital services, and satisfaction towards life-asa-whole, among the community elderly with chronic conditions. A sample of 172 Chinese elderly living in a metropolitan Taiwanese city were home-interviewed. Results indicated that (a) the elderly perceived good social support, and tangible support was the most important aspect; (b) the elderly did not perceive great impact of illness(es) upon their life, and both physical and mental health were satisfactory; (c) the elderly were generally satisfied with both the hospital services and life-as-a-whole; (d) apart from health and illness factors, social support appeared to have profound and pervasive protective effects on adjustment and satisfaction of the elderly.     

The importance of ethnic similarity in the therapist‐patient dyad among Surinamese migrants in Dutch mental health care

Empirical evidence is equivocal on whether ethnic matching in the therapist‐patient dyad is preferred by ethnic minority patients and whether it leads to treatment satisfaction. The aim of this study was to establish the importance of ethnic similarity in mental health care among Surinamese migrants in the Netherlands. A convenience sample of Surinamese out‐patients in community mental health care (N = 96) was interviewed. Data were analysed using logistic multivariate techniques. The majority of the Surinamese out‐patients (in particular recently residing participants) rated ethnic matching as relevant; a considerable minority considered compassion and expertise to be more relevant than ethnic background. Most out‐patients reported to be satisfied with the services, especially females and respondents treated by an ethnically similar therapist. Ethnic similarity in the patient‐therapist dyad is a strong predictor for satisfaction with mental health care services. However, although it is preferred by many, ethnic matching per se is no must ‐ empathy, expertise and world view sharing are reported to be of considerable importance as well.     

Racial discrimination,John Henryism coping,and behavioral health conditions among predominantly poor,urban African Americans: Implications for community‐level opioid problems and mental health services

The current study examined the relationship between John Henryism Active Coping (JHAC), experiences of racial discrimination, and behavioral health outcomes in a community sample of 319 Black adults. Assessments included primary health care screenings as well as self‐reported survey questions to assess JHAC, experiences of discrimination, and self‐reported behavioral health. Logistic regression models, adjusted for control variables, found a significant relationship between JHAC and having an opioid problem (odds ratio [OR] = 0.95, p = 0.003) and needing mental health services (OR = 0.95, p < 0.001), such that higher levels of coping were associated with lower odds of reporting an opioid problem and needing mental health services. Notably, racial discrimination was not significantly independently associated with behavioral health. Implications for interventions and community programming are discussed.     

How Is the Suicide Ideation in the Korean Armed Forces Affected by Mental Illness,Traumatic Events,and Social Support?

BackgroundSuicide is one of the leading causes of death in the military as in the general population. To mitigate such a serious public health problem, identifying the risk or protective factors of suicide behaviors is crucial.MethodsWe analyzed the representative data of the 2014 Korean Armed Forces to explore the relationship between past year adverse events (PAE), accumulated lifetime trauma (ALT), mental illness vulnerability, perceived social support, and suicidal ideation in the previous year.ResultsAmong the 6,377 subjects, 3.7% of males and 6.2% of females reported suicidal ideation in the previous year. Multivariate analytic models identified significant associations of PAE and ALT with suicidal ideation with a dose-response pattern. The mental illness vulnerability showed the most significant association with suicidal ideation even after controlling PAE or ALT. We found that perceived social support may be potentially linked with a reduced risk of suicidal ideation.ConclusionThis Korean military representative data demonstrates mental illness vulnerability; PAE; and lifetime trauma as significant risk factors of suicidal ideation, while perceived social support was found as a potential protective factor. Given the importance of the prevention of suicide in the military, those risk and protective factors may be used to screen soldiers at risk of suicide and provide further support on mental health services as needed.     

Physical Exercise in Chinese Older Adults: A Transtheoretical Model1

Physical exercise has a positive impact on physical and mental health among older adults. This study identifies significant correlates of exercise behavior among Hong Kong Chinese older adults under the transtheoretical model. The data came from a survey of a representative community sample of 425 elderly respondents in Hong Kong. Using multiple regression models, the authors found that perceived benefits of exercise and self‐efficacy for exercise were related significantly to exercise behavior, and their effects on exercise were mediated completely through the stages of changes in exercise. Although perceived barriers to exercise are significantly and negatively associated with exercise behavior, this relationship disappeared in multiple regression analysis after controlling demographic and several health‐related variables. Findings suggest that perceived benefits and self‐efficacy on exercise should be strengthened to motivate older adults to engage in a more active lifestyle.     

Adolescence dropout risk predictors: Family structure,mental health,and self-esteem

This study investigated the predictive roles of family structure, mental health, and self-esteem in dropout risk among school-going adolescents in the Ibadan Municipality of Oyo State, Nigeria. A quantitative research design approach was adopted. A total of 287 school-going adolescents with consistent record of absenteeism were randomly selected from 14 schools in the Ibadan Municipality. A single adapted questionnaire divided into sections was used to collect data. The hypotheses raised were tested using the Pearson's product–moment correlation and multiple regression analysis. The study established that the relationship between dropout risk, lack of family structure (r = 0.491, n = 287, p < 0.05), mental health (r = 0.373, n = 287, p < 0.05), and self-esteem (r = 0.428, n = 287, p < 0.05) of the participants was significant. Furthermore, the joint influence of the predictive variables (family structure, mental health, and self-esteem) was also significant on dropout risk (R = 0.489, adjusted R² of 0.398). The study concludes that dropout risk among school-going adolescents can be safeguarded with factors such as family structure, mental health, and self-esteem as guided against. Hence, the family structure, mental health, and self-esteem are very crucial if the upsurge of school dropout that is bedeviling the society will be reduced to bearable level or eradicated.     

Cluster randomised controlled trial of the effectiveness of primary care mental health workers

BACKGROUND: Mental health issues are a core part of the work of primary care and are the second most common reason for consultations. There is some evidence that the quality of primary care mental health provision is variable. AIM: To evaluate the effectiveness of primary care mental health workers with regards to satisfaction with care, mental health symptoms, use of the voluntary sector, and cost effectiveness of care. DESIGN OF STUDY: Cluster randomised controlled trial. SETTING: Practices in the Heart of Birmingham Primary Care Trust, Birmingham, England. METHOD: Nineteen practices and 368 patients (18 to 65 years of age) with a diagnosis of a new or ongoing common mental health problem were recruited. Sixteen practices and 284 patients completed the trial. RESULTS: Patients in intervention practices had a higher mean level of general satisfaction than those in control practices (difference between group scores of 8.3, 95% confidence interval = 1.3 to 15.3, P = 0.023). The two groups did not differ in mental health symptom scores or use of the voluntary sector. CONCLUSION: For patients with common mental health problems, primary care mental health workers may be effective at increasing satisfaction with an episode of care.     

Examining the effects of ethnic‐specific services: An analysis of cost‐utilization and treatment outcome for Asian American clients

Ethnic‐specific mental health services have developed to meet the unique cultural and linguistic needs of the ethnic client. It has been assumed that this type of service configuration provides more accessible, culturally‐responsive mental health care, which in turn, encourages utilization and enhances outcomes. Previous studies have found that ethnic‐specific services (ESS) increase utilization of mental health services, but there has only been inconsistent evidence that ESS results in better outcomes. This study compared patterns of the cost‐utilization and outcomes of Asian American outpatients using ESS to those Asians using mainstream services. Consistent with earlier studies, cost‐utilization for ESS Asian clients was higher than that for mainstream Asian clients. Better treatment outcome was found for ESS clients compared to their mainstream counterparts, even after controlling for certain demographics, pretreatment severity, diagnosis, and type of reimbursement. Moreover, there was a significant relationship between cost‐utilization and outcome for ESS clients, whereas for mainstream clients, this relationship was not significant. The findings strongly suggest that mental health services with an ethnic‐specific focus provide more effective and efficient care for at least one ethnic minority group. Implications for the delivery of culturally‐competent mental health services are discussed. © 2000 John Wiley & Sons, Inc.     

Attachment, social support and well-being in young and older adults

The present study examined the link between attachment, social support and well-being in young and older adults. The results from multi-group path analyses showed significant between-group differences in the links between attachment, perceived support and well-being. Anxious attachment and well-being were inversely associated and this was stronger for the younger group than it was for the older group. Avoidant attachment was negatively related to perceived support satisfaction in the older age group only, and perceived support mediated the effects of avoidant attachment on mental health and loneliness in the older group. Generally, perceived satisfaction with support was more strongly related with well-being in older adults. The results point to differential links of insecure attachment styles with perceived support in different life-stages and to related cognitive, emotional and social processes.     

Prevalence and correlates of everyday discrimination among U.S. Latinos

This study reports on the prevalence and correlates of perceived discrimination among a national sample of Latinos in the United States. Understanding the prevalence and correlates of discrimination can help us better address disparities in the health care system. The authors define perceived discrimination as self‐reported everyday experiences of unfair treatment. Logistic regression analyses were used to assess rates of perceived discrimination among Latinos and identify correlates of discrimination. Data came from the National Latino and Asian American Study (NLAAS). The prevalence of perceived discrimination among Latinos was 30%. Cubans and Latinos with high ethnic identity were less likely to perceive discrimination compared to other Latino subgroups or Latinos with low ethnic identity. American‐born Latinos and Latinos arriving in the United States at younger ages were more likely to perceive discrimination compared to immigrants arriving at older ages. Perceived discrimination among Latinos is less prevalent than what has been reported for other minorities. Variations in perceived discrimination are related to sociodemographic and cultural differences across ethnic subgroups. © 2008 Wiley Periodicals, Inc.     

A qualitative study of healthcare professionals’ perceptions of men and women's mental healthcare seeking in Rwanda

This study aimed to explore health care professionals (HCP’) perceptions about mental-health-seeking behaviours in men and women and its social and gender implications in Rwanda. Six focus group discussions including 43 HCPs working at mental health facilities and district hospitals in Rwanda were conducted. Data were analysed using qualitative content analysis. The emerging theme “Traditional gender role patterns and stigma are displayed in mental health care seeking, adherence to treatment and family effects” illustrated how HCPs perceived gender differences and outcomes in mental healthcare seeking. The theme was based on three categories: “Gender differences in health care seeking patterns,” “Gender roles and stigma affect adherence to counselling and treatment,” and “Gender roles exert an influence on family support” and related subcategories, with which each described various aspects contributing to the result. According to HCPs who regularly encountered people with mental health problems, neither men nor women with mental health problems could adequately benefit from the available mental health services because of the strong influence stigma and prevailing traditional gender roles had on men's and women's mental-healthcare-seeking behaviour. There is an urgent need for comprehensive societal interventions involving policy makers, HCPs, and the general population to diminish the stigma tied to mental illness and the traditional gender norms that negatively influence healthcare-seeking patterns; such actions can improve the health of many citizens.