多水平模型在社区成人精神障碍现况及服务利用研究的应用(综述)

精神卫生流行病学调查多采用复杂抽样设计抽样方法,由此获得的数据具有多层次结构,使用传统的单水平多因素分析的方法会得出有偏差的结论。多水平模型把传统意义上来自生态学和个体水平上截然不同的两方面信息相结合,克服了只聚焦于单一水平的局限性,在众多领域得到了应用。本文综述了多水平模型在精神卫生领域两个方面应用的研究进展,即精神障碍影响因素研究及精神障碍患者卫生服务利用的影响因素研究,以期为未来多水平模型在精神卫生领域研究中的规范应用提供建议和参考。     

"积分悖论干预法"的操作技术与临床应用

目的:介绍一种在实践中形成的悖论干预取向的治疗技巧--积分悖论干预法.方法:"积分悖论干预法"的操作特点是在治疗初期不但不寻求消除症状,相反而要主动发动和加重症状,最终消除症状.操作原则: 定时、定量主动发动和体验症状,或者在现实情境中主动诱发症状,加重和扩大症状,假装或表演症状,操纵症状,对诱发的症状进行评分,积累症状分数,达到消除症状.积累分数的评估过程具有使自我把症状痛苦"客体化"的效果.结果:通过对42例咨客实施治疗,取得不同程度疗效,并报告了两个案例的典型治疗过程.结论:"积分悖论干预法"适合治疗大中小学生的各种心理问题,特别对轻度强迫思维、强迫意象及学校恐怖等问题疗效较好.     

Supporting the mental health needs of underserved communities: A qualitative study of barriers to accessing community resources

This study examined the accessibility of community resources (e.g., welfare programs and afterschool programs) for underserved youth and families with mental health needs. Mental health professionals (n = 52) from a large community mental health and welfare agency serving predominantly low-income, Latinx families completed a semistructured interview that asked about the accessibility of community resources. Participant responses were coded using an inductive thematic analysis. Results showed that 71% of participants endorsed availability barriers (e.g., limited local programs), 37% endorsed logistical barriers (e.g., waitlists), 27% endorsed attitudinal barriers (e.g., stigmatized beliefs about help-seeking), and 23% endorsed knowledge barriers (e.g., lacking awareness about local programs). Professionals' perceived availability barriers were mostly consistent with the actual availability of community resources. Findings highlight the compounding challenges that underserved communities face and point to opportunities for promoting enhanced well-being and functioning for youth and families with mental health needs.     

A Comparison Between Phone-Based Psychotherapy With and Without Text Messaging Support In Between Sessions for Crisis Patients

Background

Few studies have tested whether individually tailored text messaging interventions have an effect on clinical outcomes when used to supplement traditional psychotherapy. This is despite the potential to improve outcomes through symptom monitoring, prompts for between-session activities, and psychoeducation.

Objective

The intent of the study was to explore the use of individually tailored between-session text messaging, or short message service (SMS), as an adjunct to telephone-based psychotherapy for consumers who present to the Emergency Department (ED) in situational and/or emotional crises.

Methods

Over a 4-month period, two therapists offered 68 prospective consumers of a telephone-based psychotherapy service individually tailored between-session text messaging alongside their telephone-based psychotherapy. Attendance and clinical outcomes (depression, anxiety, functional impairment) of those receiving messages were compared against a historical control group (n=157) who received telephone psychotherapy only.

Results

A total of 66% (45/68) of the consumers offered SMS accepted the intervention. A total of 432 messages were sent over the course of the trial, the majority involving some kind of psychoeducation or reminders to engage in therapy goals. There were no significant differences in clinical outcomes between consumers who received the SMS and those in the control group. There was a trend for participants in the intervention group to attend fewer sessions than those in the control group (mean 3.7, SD 1.9 vs mean 4.4, SD 2.3).

Conclusions

Both groups showed significant improvement over time. Individually tailored SMS were not found to improve clinical outcomes in consumers receiving telephone-based psychotherapy, but the study was underpowered, given the effect sizes noted and the significance level chosen. Given the ease of implementation and positive feedback from therapists and clients, individually tailored text messages should be explored further in future trials with a focus on enhancing the clinical impact of the tailored text messages, and utilizing designs with additional power to test for between-group effects.     

Responsiveness in Psychotherapy

Human interaction, including psychotherapy, is systematically responsive; therapists' and clients' behavior is influenced by emerging context, including perceptions of each other's characteristics and behavior. Feedback and mutual influence occur on a wide range of time scales, including treatment assignment, strategy, and tactics, -and even within the delivery of interventions. Consequently, research that assumes linear relations among psychotherapeutic variables may not be trustworthy. The concept of responsiveness helps show how client characteristics, therapist characteristics, and process components may be important in psychotherapy despite a lack of linear relations to outcomes. Research strategies that incorporate responsiveness include the use of evaluative measures, systems approaches, and qualitative and narrative approaches.     

Graduate mental health worker case management of depression in UK primary care: a pilot study.

BACKGROUND: Based on data from large multicentre US trials, the National Institute for Health and Clinical Excellence (NICE) is advocating a stepped-care model for the management of depression, with 'case management' or 'collaborative care' for selected patients in primary care. AIM: To conduct a pilot study examining the use of graduate mental health workers case managing depressed primary care NHS patients. DESIGN OF STUDY: A randomised controlled trial comparing usual GP care with or without case management over 16 weeks of acute antidepressant drug treatment. SETTING: Three primary care practices in the North East of England. METHOD: Patients with depression, aged 18-65 years, who had failed to adequately respond to antidepressant treatment, were randomised to the two treatments. Assessments were made at baseline, 12, and 24 weeks using a combination of observer and self ratings. RESULTS: Randomisation of 62 patients required screening of 1073 potential patients. There was little difference in outcome between the two treatment arms but a gradual improvement in symptoms over time was seen. Client satisfaction was assessed as high across both treatments. CONCLUSION: While this pilot study confirmed the integrity of the study protocol and the suitability of the outcome measures and randomisation procedure, it raises questions regarding the practicality of recruitment and feasibility of the intervention. It would be crucial to address these issues prior to the implementation of a large multi-centre randomised controlled trial.     

农村中学生精神卫生状况影响因素分析

目前，青少年心理健康问题日益受到重视，有关大、中学生的心理卫生调查研来已有不少报道’－‘。为了解农村中学生的精神卫生状况，寻找影响其心理健康的相关因素．并为预防心理疾病提供参考依据．我们对劲利县第七中学的中学生进行了调查。1资料及方法1．1对象选择我校高一至高三的学生，采取分层整群抽样方法，每年级抽取一个班共156人，男94人、女62人；一年级52人、二年级46人、三年级58人；年龄15～20岁·平均164士25岁。1·2方法采用症状自评量表（SCI，－90）［‘j和修订的艾森克个性问卷（EPQ）［’：；按指导语对每个学生进行…     

Psychotherapy for veterans navigating the military-to-civilian transition: A case study

Veterans face a range of challenges as they transition out of the military and into civilian life. For some, this period of transition is characterized by loss of identity, loss of daily structure, loss of community, and confusion about where they fit within society. If not attended to, problems associated with the military-to-civilian transition can lead to significant functional impairment. Yet, little is known about how psychotherapy can support this period of adjustment that every veteran will face. This article presents a case study of a veteran struggling to adjust to the civilian world following his service in the military. Critical areas of assessment, conceptualization, and intervention are explicated to help inform best practices for mental health providers working with veterans.     

Should We Allow Psychotherapy Research to Determine Clinical Practice?

We address some of the objections, raised by Carfield and others, to the strong application of outcome research to psychotherapy practice. We argue that while Carfield has offered strong arguments for each of these objections, they do not amount to a sufficient case against the radical application of outcome research. We describe an alternative model for the integration of psychotherapy research with clinical procedures, in which the effective clinical service rests on research findings, professional consensus based on training and continuing education, evidence-based systematic practice, and monitoring of service delivery and outcomes. This close collaboration between outcome researchers and clinicians would, we believe, enrich the work of both, and the field of psychotherapy as a whole.     

Digital mental health outcome monitoring for a structured text-based youth counselling intervention: Demographic profile and outcome change

Background

Digital mental health interventions comprise a potentially effective and accessible form of support for young people, particularly at times when traditional face-to-face service delivery is reduced, as in the COVID-19 pandemic.

Aims

This study assessed the demographic profile of young people using a digital mental health support service and evaluated outcome change over the course of a structured online counselling intervention (synchronous text-chat sessions with a practitioner).

Materials and Methods

The data were collected from 23,260 young people aged between 10 and 25 years engaging with the intervention between April 2019 and June 2021.

Results

Young people accessing these services had high levels of mental health needs, particularly those identifying with non-binary gender identity. Service users were mostly female, with equitable rates of access for young people from racialised communities. Overall outcome change demonstrated small effect sizes according to the YP-CORE (0.19) and CORE-10 (0.38), which increased to a moderate level when young people remained engaged with a dedicated practitioner for at least seven sessions (0.38, 0.58). Regression analysis illustrated the effect of the number of sessions on outcome change, but this can be also influenced by other variables such as age and gender.

Discussion and Conclusion

Further research is required to explore ways to engage with young people using digital web-based services for a longer period and to collect and analyse single-session outcome data.     

Implementing the role of the primary care mental health worker: a qualitative study

BACKGROUND: Primary care mental health workers are a new role recently introduced into primary care in England to help manage patients with common mental health problems. AIM: To explore the views of GPs, primary care teams and patients on the value and development of the new role of primary care mental health workers in practice. DESIGN OF STUDY: Qualitative study. SETTING: The Heart of Birmingham Primary Care Teaching Trust in the West Midlands, UK. METHOD: Thirty-seven semi-structured interviews involving seven primary care mental health workers, 21 patients and 11 focus groups involving 38 members of primary care teams were held with six teams with a worker. Two teams asked for the worker to be removed. Six practice managers also took part in the study. RESULTS: A number of different approaches were used to implement this new role. Strategies that incorporated the views of primary care trust senior management, primary care teams and workers' views appeared most successful. Rapid access to a healthcare professional at times of stress and the befriending role of the worker were also highly valued. Workers felt that their role left them professionally isolated at times. A number of workers described tension around ownership of the role. CONCLUSION: Primary care mental health workers appear to provide a range of skills valued by patients and the primary care teams and can increase patient access and choice in this area of health care. Successful implementation strategies highlighted in this study may be generalisable to other new roles in primary care.