A longitudinal study of mental health consumer/survivor initiatives: Part 2—A quantitative study of impacts of participation on new members

To evaluate the impacts of participation in mental health Consumer/Survivor Initiatives (CSIs), we used a nonequivalent control group design to compare new, active participants in CSIs ( n = 61) with nonactive participants ( n = 57) at baseline, 9‐month, and 18‐month follow‐up intervals. The two groups were comparable at baseline on a wide range of demographic variables, self‐reported psychiatric diagnosis, service use, and outcome measures. At 9 months, there was a significant reduction in utilization of emergency room services for active participants, but not for nonactive participants. At 18 months, the active participants showed significant improvement in social support and quality of life (daily activities) and a significant reduction in days of psychiatric hospitalization, whereas the nonactive participants did not show significant changes on these outcomes. Also, active CSI participants were significantly more likely to maintain their involvement in employment (paid or volunteer) and/or education over the 18‐month follow‐up period when compared with those who were not active in CSIs. These results are discussed in the context of the self‐help literature and their policy implications for people with mental illness. © 2006 Wiley Periodicals, Inc.     

A longitudinal study of mental health consumer/survivor initiatives: Part V–Outcomes at 3‐year follow‐up

The objective of this study was to evaluate the impacts of participation in mental health Consumer/Survivor Initiatives (CSIs), organizations run by and for people with mental illness. A nonequivalent comparison group design was used to compare three groups of participants: (a) those who were continually active in CSIs over a 36‐month period (n = 25); (b) those who had been active in CSIs at 9‐ and 18‐month follow‐up periods, but who were no longer active at 36 months (n = 35); and (c) a comparison group of participants who were never active in CSIs (n = 42). Data were gathered at baseline, 9‐, 18‐, and 36‐month follow‐ups. The three groups were comparable at baseline on a wide range of demographic variables, self‐reported psychiatric diagnosis, service use, and outcome measures. At 36 months, the continually active participants scored significantly higher than the other two groups of participants on community integration, quality of life (daily living activities), and instrumental role involvement, and significantly lower on symptom distress. No differences between the groups were found on other outcome measures. Improvements in 36‐month outcomes for people with mental illness who participated in CSIs suggest the potential value of these peer support organizations. Further research is needed to determine the replicability of these positive findings. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 655–665, 2007.     

A Longitudinal study of mental health consumer/survivor initiatives: Part 4—Benefits beyond the self? A quantitative and qualitative study of system‐level activities and impacts

The purpose of this article is to report on the system‐level findings of a longitudinal study of four mental health consumerñrun self‐help organizations. Quantitative and qualitative data revealed that staff and members of the four Consumer/Survivor Initiatives (CSIs) participated actively in system‐level activities, including community planning, public education, advocacy, and action research. The qualitative data revealed a number of perceived system‐level outcomes related to these activities: (1) changes in perceptions (changed perceptions of the public and mental health professionals about mental health or mental illness, the lived experience of consumer/survivors, the legitimacy of their opinions, and the perceived value of CSIs) and (2) concrete changes (tangible changes in service delivery practice, service planning, public policy, or funding allocations). These findings are discussed in the context of previous work on system‐level activities and impacts of consumer/survivor organizations. © 2006 Wiley Periodicals, Inc.     

Taking time to feel our body: Steady increases in heartbeat perception accuracy and decreases in alexithymia over 9 months of contemplative mental training

The ability to accurately perceive signals from the body has been shown to be important for physical and psychological health as well as understanding one's emotions. Despite the importance of this skill, often indexed by heartbeat perception accuracy (HBPa), little is known about its malleability. Here, we investigated whether contemplative mental practice can increase HBPa. In the context of a 9‐month mental training study, the ReSource Project, two matched cohorts (n = 77 and n = 79) underwent three training modules of 3 months' duration that targeted attentional and interoceptive abilities (Presence module), socio‐affective (Affect module), and socio‐cognitive (Perspective module) abilities. A third cohort (n = 78) underwent 3 months of practice (Affect module) and a retest control group (n = 84) did not undergo any training. HBPa was measured with a heartbeat tracking task before and after each training module. Emotional awareness was measured by the Toronto Alexithymia Scale (TAS). Participants with TAS scores > 60 at screening were excluded. HBPa was found to increase steadily over the training, with significant and small‐ to medium‐sized effects emerging after 6 months (Cohen's d = .173) and 9 months (d = .273) of mental training. Changes in HBPa were concomitant with and predictive of changes in emotional awareness. Our results suggest that HBPa can indeed be trained through intensive contemplative practice. The effect takes longer than the 8 weeks of typical mindfulness courses to reach meaningful magnitude. These increments in interoceptive accuracy and the related improvements in emotional awareness point to opportunities for improving physical and psychological health through contemplative mental training.     

Breast and cervical cancer screening for women with mental illness: patient and provider perspectives on improving linkages between primary care and mental health

Summary Objective: Previous research suggests that women with mental illness may be at increased risk for breast and cervical cancer. This qualitative study of patients and primary care and mental health providers explored challenges to accessing and providing breast and cervical cancer screening for women with mental illness. Method: Key informant patient and provider participants were recruited from a community health setting and teaching hospital. Narrative data from 1) interviews with women in a community primary care setting (n = 16); 2) telephone interviews with women with mental illness (n = 16); and 3) focus groups with primary care providers (n = 9) and mental health providers (n = 26) were collected. Results: Patient, provider, and system factors that may contribute to suboptimal cancer screening among women with mental illness were identified. Communication between primary care and mental health providers was noted as a key area for intervention to enhance screening. Barriers to and possibilities for a more proactive role for mental health providers were also considered. Conclusions: Both patient and provider study participants emphasized the need to address communication gaps between primary care and mental health providers and to promote the active collaboration of mental health providers in preventive cancer screening for women with mental illness.     

A 12‐month follow‐up study of self‐management training for people with chronic disease: Are changes maintained over time?

Objective. A previous study reported some improved outcomes at 4‐month follow‐up after attendance on a lay‐led, chronic disease self‐management course (CDSMC). The purpose of this study was to determine whether changes were maintained over time (i.e. at 12 months) and to describe participants' current use of self‐management techniques. Design. The study was a 12‐month follow‐up of a sample of 171 participants who attended a CDSMC in the UK. Method. Data were collected by self‐administered questionnaires mailed to participants 12 months after they commenced a CDSMC and via telephone interviews with a sub‐sample. Results. The sample had a mean age of 54 years, mean disease duration of 16 years, 73% were women, and chronic diseases included endometriosis, depression, diabetes, myalgic encephalomyelitis, osteoporosis and polio. The significant improvements in outcomes identified at 4 months (i.e. cognitive symptom management, self‐efficacy, communication with physician, fatigue, anxious and depressed moods and health distress) were sustained at 12 months. No significant changes between 4‐ and 12‐month assessments were found on any study variables. Interview data confirmed that participants continued to use some of the self‐management techniques learned on the course. Conclusion. Attendance on the CDSMC may lead to longer‐term changes in key outcomes such as self‐efficacy, use of some self‐management behaviours and some aspects of health status (e.g. fatigue, depressed mood).     

A theory-based intervention to reduce alcohol drinking in excess of guideline limits among undergraduate students

Objectives. Undergraduate students frequently exceed guideline limits for alcohol intake in a single session and are highly susceptible to associated health, social, and economic problems. Psychological theory suggests that interventions aimed at reducing alcohol consumption should target both motivational and volitional phases of action to be effective. This study reports an integrated theory‐based intervention aimed at reducing undergraduates’ alcohol consumption in excess of guideline limits. Design. The study adopted a 2 (motivation: mental simulation vs. no mental simulation) × 2 (volitional: implementation intention vs. no implementation intention) randomized controlled design presented in an online format. Methods. Undergraduate students (N= 238; females, n= 133, M age = 20.11, SD= 2.09; males, n= 105, M age = 20.38, SD= 1.35) completed baseline psychological measures and self‐reported alcohol consumption as units consumed and heavy episodic drinking occasions followed by the intervention manipulation (if any). One month later participants completed follow‐up measures of the psychological variables and alcohol consumption. Results. Significant reductions in alcohol consumption were observed at follow‐up. Participants receiving a mental simulation intervention reported significantly fewer units of alcohol consumed and heavy episodic drinking occasions. Among participants with high baseline alcohol consumption, participants in the combined mental simulation and implementation intention intervention group consumed significantly fewer units than other groups. Conclusion. Results support the use of these theory‐based strategies to reduce alcohol drinking in excess of guideline limits among undergraduates. There was preliminary support for the interaction between the two strategies among heavier drinkers. Targeting both motivational and implemental phases of action poses a high probability for success in changing alcohol‐related behaviour in this population.     

SUPPORTING THE SUPPORTERS: A RANDOMIZED CONTROLLED TRIAL OF INTERVENTIONS TO ASSIST THE LEADERS OF CANCER SUPPORT GROUPS

As more skilled cancer support group leaders create better outcomes for group members, it is important to provide training for this population. The aim of this randomized controlled trial was to evaluate the effect of a low resource demanding (LRD) versus a high resource demanding (HRD) intervention. Leaders were randomized to receive either an LRD (access to a website and discussion forum only) or an HRD intervention (access to the website and discussion forum, DVD, and manual, plus a 2‐day training workshop). Pre‐ and postintervention assessment was conducted using 3 standardized measures. Sixty‐five leaders (HRD n = 35; LRD n = 30) participated, with postintervention data collected from 54 leaders (83%). Pre‐ and postintervention, leaders reported low levels of challenge and high levels of psychological well‐being and confidence. Comparative analysis revealed no significant group differences (all p > .05). However, in semistructured interviews (n = 12) and focus groups (n = 8), leaders reported that training had positive effects, despite barriers to intervention use.     

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.     

Sleep disturbance mediates the association of adverse childhood experiences with mental health symptoms and functional impairment in US soldiers

Adverse childhood experiences (ACEs) can have long‐term impacts on a person's mental health, which extend into adulthood. There is a high prevalence of ACEs among service members. Further, service members also report frequently experiencing disrupted sleep. We hypothesized that disrupted sleep may serve a mechanistic function connecting ACEs to functional impairment and poorer mental health. In a cross‐sectional sample (n = 759), we found evidence for an indirect effect of ACEs on mental health outcomes through disrupted sleep. In a different sample using two time‐points (n = 410), we found evidence for an indirect effect of ACEs on changes in mental health outcomes and functional impairment during a reset period, through changes in disrupted sleep during the same period. Implications, limitations and future research directions are discussed.     

A qualitative investigation to inform yoga intervention recruitment practices for racial/ethnic minority adolescents in outpatient mental health treatment

ObjectiveYoga is recognized as an effective approach to improving overall physical and mental health; however, there may be perceived barriers to yoga participation, particularly among populations most at risk for mental health issues. We conducted qualitative formative research to help inform recruitment practices for a future study and to specifically understand the barriers and facilitators to engagement in yoga practice among racial/ethnic minority adolescents, as well as adolescents in outpatient mental health treatment.MethodsQualitative data were collected at a community health clinic that serves low income families in southeastern Florida. Using semi structured interviews with racial and ethnic minority adolescents between 12 and 17 years old, participants were asked about beliefs and perceptions about yoga, as well as recommendations on recruiting peers. A thematic analysis approach was used to identify and examine common themes.ResultsTwenty interviews were conducted and eight major themes emerged from the data. Themes were grouped as (1) Facilitators to recruitment and (2) Barriers to recruitment.InterpretationAdvertising free yoga that emphasizes the social, physical, and mental benefits can help assuage negative perceptions of yoga and promote the advantages of yoga among teenagers. Having recruitment materials and modalities that highlight inclusivity of all genders and physical abilities in the yoga classes are also important in facilitating participation. Understanding perceptions of yoga, as well as perceived barriers and facilitators, among racially/ethnically diverse adolescents in outpatient mental health treatment, can assist recruitment efforts, increase yoga intervention participation, and ultimately, improve mental health outcomes for underserved populations.     

The effects of sustained COVID-19 emergency and restrictions on the mental health of subjects with serious mental illness: A prospective study

Few longitudinal studies have so far investigated the impact of sustained COVID-19 among people with pre-existing psychiatric disorders. We conducted a prospective study involving people with serious mental illness (n = 114) and healthy controls (n = 41) to assess changes in the Perceived Stress Scale, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, and Specific Psychotic Experiences Questionnaire scores 18 months after the COVID-19 pandemic outset. Subjects underwent interviews with a mental health professional in April 2020 and at the end of the local third wave (October 2021). A significant increase in perceived stress was found in healthy controls, especially females. Psychiatric patients showed a significant worsening of anxiety symptoms compared to baseline records (t = −2.3, p = 0.036). Patients who rejected vaccination had significantly higher paranoia scores compared to those willing to get vaccinated (U = 649.5, z = −2.02, p = 0.04). These findings indicate that COVID-19's sustained emergency may cause enduring consequences on mental health, soliciting further investigations.     

Validation of A brief sense of community scale: Confirmation of the principal theory of sense of community

First‐order and second‐order models of sense of community (SOC) were tested using confirmatory factor analysis (CFA) of data gathered from a random sample of community residents (n=293) located in the midwestern United States. An 8‐item Brief Sense of Community Scale (BSCS) was developed to represent the SOC dimensions of needs fulfillment, group membership, influence, and shared emotional connection. The CFA results for the BSCS supported both the scale's hypothesized first‐order and second‐order factor structure. The overall BSCS scale and its subscales were also found to be correlated as expected with community participation, psychological empowerment, mental health, and depression. Findings provide empirical support for the BSCS and its underlying multidimensional theory of SOC. Implications of the study are described and directions for future research discussed. © 2007 Wiley Periodicals, Inc.     

A randomized trial of computer‐based communications using imagery and text information to alter representations of heart disease risk and motivate protective behaviour

Objective. Advances in web‐based animation technologies provide new opportunities to develop graphic health communications for dissemination throughout communities. We developed imagery and text contents of brief, computer‐based programmes about heart disease risk, with both imagery and text contents guided by the common‐sense model (CSM) of self‐regulation. The imagery depicts a three‐dimensional, beating heart tailored to user‐specific information. Design. A 2×2×4 factorial design was used to manipulate concrete imagery (imagery vs. no imagery) and conceptual information (text vs. no text) about heart disease risk in prevention‐oriented programmes and assess changes in representations and behavioural motivations from baseline to 2 days, 2 weeks, and 4 weeks post‐intervention. Methods. Sedentary young adults (N= 80) were randomized to view one of four programmes: imagery plus text, imagery only, text only, or control. Participants completed measures of risk representations, worry, and physical activity and healthy diet intentions and behaviours at baseline, 2 days post‐intervention (except behaviours), and 2 weeks (intentions and behaviours only) and 4 weeks later. Results. The imagery contents increased representational beliefs and mental imagery relating to heart disease, worry, and intentions at post‐intervention. Increases in sense of coherence (understanding of heart disease) and worry were sustained after 1 month. The imagery contents also increased healthy diet efforts after 2 weeks. The text contents increased beliefs about causal factors, mental images of clogged arteries, and worry at post‐intervention, and increased physical activity 2 weeks later and sense of coherence 1 month later. Conclusion. The CSM‐based programmes induced short‐term changes in risk representations and behaviour motivation. The combination of CSM‐based text and imagery appears to be most effective in instilling risk representations that motivate protective behaviour.     

Predicting Objectively Measured Exercise Participation from Motivation and Basic Needs Satisfaction: Does a Mediational Model Exist?

This study (a) explored whether relationships exist between objectively assessed exercise participation and both controlled extrinsic motivation and amotivation, and (b) investigated the possible mediation of the relationships between satisfaction of the basic needs and objectively assessed exercise participation. Participants (n = 162) were members of a worksite wellness program. Before beginning the program, participants completed a 33‐item survey measuring the constructs of self‐determination theory. Objectively assessed exercise participation was measured via attendance. Path analysis revealed that the net effect of external regulation on attendance was positive. Of the basic needs, only autonomy was a significant predictor of attendance, with no mediation of this relationship. Appealing to participants' external regulation and need for autonomy may enhance exercise participation.     

Applicability of consumer activity monitor data in marathon events: an exploratory study

Emerging opportunities to measure individual and population-level health data with activity monitors during recreational running activities may set the stage for new research possibilities in mass participation running events and marathon medicine. This study explores the applicability of consumer activity monitor data in a preliminary study for future marathon health research with a cohort of 12 (n?=?12) participants completing a 3.379?km walking or running course. This study explored the feasibility of collecting pace and distance data from Fitbit brand consumer activity monitors, from access to user data to reporting of data characteristics and data analysis. We show that a large percentage of participant data can be successfully retrieved from Fitbit consumer activity monitor devices for analysis in marathon health research, and that identifying variations in pace across participants is a practical possibility. We note a mean absolute percentage error of 13% over the true distance of 3.379?km, a higher error than that reported by other studies. We also observe a Pearson correlation coefficient between participant variation in pace and absolute distance error of 0.61. This study provides preliminary evidence to support the applicability of consumer activity monitor data in marathon health research.     

The effectiveness of single session therapy in child and adolescent mental health. Part 2: An 18‐month follow‐up study

Objectives . This study examines whether the short‐term benefits of planned single session therapy (SST), previously demonstrated for child and adolescent clients with mental health problems, are maintained over an 18‐month period. It also investigates the impact of an initial 6‐week delay on therapy, and the impact of additional therapy during the 18‐month period. Design . The study is an 18‐month follow‐up to a cross‐sectional clinical study involving treatment of outpatients at a public mental health clinic, over 14 months. All clients had been administered SST. Measures used were those used in the original study, which had a 1‐month post‐SST follow‐up. Method . Each client was assessed using the DSMD, CSQ‐8 and the frequency and severity of the major presenting problem. Analysis was performed using repeated measures t tests and one‐way repeated measures ANOVA. Results . The study found that the short‐term benefits of SST (measured 1‐month after therapy) were maintained 18 months after the initial consultation. Delay of treatment (by 6 weeks) did not appear to impact either the short‐term or longer‐term results. An additional finding was that about 60% of the group made significant clinical improvement after one session of therapy. In the other cases, one or more extra sessions were provided to consolidate change or maintain improvements. Conclusions . The previously demonstrated short‐term benefits of SST, for children and adolescents with a range of mental health problems, were shown to be maintained over an 18‐month period. However, some clients may benefit from booster sessions. Overall, SST appears to be an empirically supported, cost effective, and beneficial form of therapy for children and adolescents with mental health problems.     

The predictive power of insomnia symptoms on other aspects of mental health during the COVID-19 pandemic: a longitudinal study

Symptoms of insomnia are an important risk factor for the development of mental disorders, especially during stressful life periods such as the coronavirus disease 2019 (COVID-19) pandemic. However, up to now, most studies have used cross-sectional data, and the prolonged impact of insomnia symptoms during the pandemic on later mental health remains unclear. Therefore, we investigated insomnia symptoms as a predictor of other aspects of mental health across 6 months, with altogether seven assessments (every 30 days, t0–t6), in a community sample (N = 166–267). Results showed no mean-level increase of insomnia symptoms and/or deterioration of mental health between baseline assessment (t0) and the 6- month follow-up (t6). As preregistered, higher insomnia symptoms (between persons) across all time points predicted reduced mental health at the 6-month follow-up. Interestingly, contrary to our hypothesis, higher insomnia symptoms at 1 month, within each person (i.e., compared to that person's symptoms at other time points), predicted improved rather than reduced aspects of mental health 1 month later. Hence, we replicated the predictive effect of averagely increased insomnia symptoms on impaired later mental health during the COVID-19 pandemic. However, we were surprised that increased insomnia symptoms at 1 month predicted aspects of improved mental health 1 month later. This unexpected effect might be specific for our study population and a consequence of our study design. Overall, increased insomnia symptoms may have served as a signal to engage in, and successfully implement, targeted countermeasures, which led to better short-term mental health in this healthy sample.     

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.     

RIPPLE EFFECTS OF IMPLEMENTING EVIDENCE‐BASED MENTAL HEALTH INTERVENTIONS IN A COMMUNITY‐BASED SOCIAL SERVICE ORGANIZATION

Concerns over the quality of mental health services in the United States have led to the creation, dissemination, and implementation of evidence‐based mental health interventions (EBMHIs). Though it is widely acknowledged that interventions have ripple effects, the effects of these interventions on the systems in which they are implemented (i.e., practice settings) are unclear. The purpose of this qualitative pilot study was to explore both practitioner‐ and organization‐level ripple effects of EBMHIs implemented in a community‐based agency. We identified 4 categories of effects on practitioners (work roles and responsibilities, knowledge, thoughts and feelings, and behavior and communication) and 2 categories of effects on the organization (structure, programming). Findings suggest that it is possible to identify ripple effects through qualitative interviews. Implications for future research on mental health intervention effects are discussed.