Psychiatric Quarterly最新文献

Background: The goal of supported housing, aside from exiting homelessness, is to improve overall quality of life. The contribution of factors that enhance quality of life in supported housing programs, beyond housing itself, have not been empirically identified.

Methods: Five-year follow-up data from two arms of a randomized trial comparing case management with and without housing vouchers (n = 278) were examined to identify correlates of improved quality of life, beyond housing resources.

Results: Access to a housing contributed to 4% of the variance in improved quality of life. Improvement in psychiatric symptoms, alcohol and drug use, employment, total income, and social support were associated with an additional 34-43% of variance in improved quality of life above and beyond housing.

Conclusion: Improvements in quality of life were more strongly associated with improvements in mental health and other aspects of social well-being than housing alone.

As a crucial component of child development, maternal-infant attachment influences a child's cognitive, psychological, and social development. Maternal depression, anxiety, stress, and social support have been identified as risk factors for poor maternal-infant attachment in some studies, while others did not find such relationships. The aim of this study was to examine the associations of maternal-infant attachment with depression, anxiety, affective instability, stress, social support, and other variables in a community sample of Canadian postpartum women. A total of 108 Canadian postpartum women participated in this cross-sectional study. The Depression, Anxiety, and Stress Scale-21 (DASS-21) assessed depression, anxiety, and stress, and the Affective lability Scale-18 measured affective instability (AI). Multiple linear regression was conducted to examine the association between maternal-infant attachment and other variables. The findings revealed a significant association of maternal-infant attachment with postpartum depression, and infant temperament, while anxiety, AI, stress, and social support were not identified as predictors for maternal-infant attachment. The results implicate the importance of addressing maternal depression and maternal-infant attachment, consequently decreasing the risk for childhood psychopathology.

Efforts to reduce the global burden of common mental disorders have focused on scaling up evidence-based training programs for non-specialist providers to deliver brief psychological interventions. To evaluate these provider training programs, appropriate and scalable assessments of competency need to be developed alongside them. We followed a systematic approach for the cultural adaptation and translation into Hindi of a valid, English, multiple-choice applied knowledge measure to assess non-specialists' competence to deliver a brief psychological intervention for depression in rural India. We then explored the relationship between the performance of 30 non-specialist providers on the same written measure compared with a structured performance-based measure consisting of two role-plays. The results of the multiple-choice assessment had an overall mean score of 37.40 (SD = 11.31) compared to the mean scores of role-play A (the easier role-play) of 43.25 (SD = 14.50) and role-play B (the more difficult role-play) of 43.25 (SD = 13.00). Role-play performance-based measures and written applied knowledge measures represent different approaches with unique strengths and challenges to measuring competence. Scaling up training programs requires the development of scalable methods for competency assessment. Exploring the relationship between these two measures, our team found no apparent differences between the two modes of assessment. Continued comparison of these approaches is needed to determine the consistency of outcomes across the two formats and to link the scores on these measures with clinical performance as reflected by the quality of care and patient outcomes.Trial Registration: ClinicalTrials.gov Identifier: NCT04157816; 8th November 2019.

The prevalence of anxiety symptoms in children and adolescents aged 4 to 18 years has nearly doubled after the first year of the pandemic. However, only one in five adolescents diagnosed with anxiety is treated. We R H.O.P. E. is a school-based mental health program that includes evidence-based principles designed to engage children and adolescents in anxiety treatment, including wellness and emotional regulation, and the emotional CPR method. We R H.O.P. E. augments traditional services provided by school administrators, school social workers, school teachers, and school nurses. The purpose of this study was to examine the feasibility, acceptability, and preliminary effectiveness of We R H.O.P. E.

The refugee crisis is spreading rapidly, with the number of global refugees this decade doubling in comparison to the last, leading to further concern regarding asylum policies and their psychological impacts. The aim of this systematic review is to further emphasize the correlation between familial separation and the risk of mental health disorders in refugees. This particular review uses quantitative and qualitative data sourced from a variety of countries to comparatively view the mental health status of approximately 8,737 refugees ages 15 and older. This was done to determine if familial separation could potentially impact their overall quality of life. As a result, separation from one's family was found to be correlated with symptoms of posttraumatic stress disorder, depression, anxiety, adult separation anxiety disorder, intermittent explosive disorder, and more. Studies reported a high variance in the prevalence of mental health disorders when models were adjusted for family separation. Methods to improve asylum procedure and mental health services for refugees is taken into consideration.

Psychiatric patient assaults on staff are a worldwide occupational hazard for health care staff that results in medical injury, human suffering, and dollar cost expense. International research through 2000-2017 documented the continued frequency of these assaults and a continuing high risk for nursing personnel. This present paper reviewed the international published literature on staff victims of patient assaults during the next five-year period of 2017-2022. There were 39,034 assaults on 34,679 employee victims. The findings indicate that assaults on staff remain a serious worldwide issue as it has been since the 1990s and that nursing personnel continued to be at greater risk. Aggression management approaches, post-incident interventions, and an updated methodological inquiry are presented.

The purpose of the study is to analyse the patterns of antipsychotic use for pregnant women in an Australian Principal Referral and Specialist Women and Newborn Hospital. This retrospective, observational study involved an analysis of dispensing data of antipsychotics from 1998 to 2014 extracted from the pharmacy dispensing systems. The study included 282 antipsychotic dispensings in the years 1999 to 2006 and 3041 dispensings in the years 2007 to 2014. Second-generation antipsychotic use during pregnancy increased over time, while first-generation-antipsychotics showed declining trend. The use of quetiapine has increased from 2.9% of total antipsychotic dispensings in 2002 up to 77.9% of total antipsychotic dispensings in 2008. Olanzapine use decreased from 78.1% in 2003 to around 20% since 2006. When comparing the age distribution, there was an increased proportion of patients receiving antipsychotics in the 30-39 age range in the second period of 2007 to 2014 compared to 1999 to 2006. The proportion of women on more than one antipsychotic increased from 5% (n = 8) to 9.8% (n = 81) when comparing between 1999 and 2006 and between 2007 and 2014. Our findings indicate a significant shift in prescribing patterns over the study period, with the increased use of antipsychotics, particularly the emergence of SGAs from 2007, changing trends in the use of specific medications as published findings on their safety profiles becomes evident, and more polypharmacy prescribing.

Purpose: Loneliness among the elderly is a widespread phenomenon and is connected to various negative health outcomes. Nevertheless, loneliness among elderly inpatients, especially those with a psychiatric diagnosis, has hardly been examined. Our study assessed loneliness in elderly inpatients, identified predictors, and compared levels of loneliness between inpatients on psychiatric and somatic wards.

Methods: N = 100 elderly inpatients of a somatic and psychiatric ward were included. Levels of loneliness were assessed, as were potential predictors such as depression, psychological resilience, severity of mental illness, well-being, daily functioning, and psychiatric diagnosis. Analyses of group differences and hierarchical multiple regression analysis were conducted.

Results: 37% of all inpatients reported elevated levels of loneliness. Significant predictor variables were self-reported depressive symptoms, well-being, severity of mental illness, being single and living with a caregiver. Hierarchical multiple regression analysis revealed that the full model explained 58% of variance in loneliness. Psychiatric inpatients' loneliness was significantly higher than loneliness in somatic inpatients. When analyzing group differences between inpatients with different main psychiatric diagnoses, highest levels were found in patients with an affective disorder, followed by those treated for organic mental disorder. Since the study took place during the COVID-19 pandemic, potential influence of different measurement points (lockdown vs. no lockdown) were analyzed: Differences in loneliness depending on the phase of the pandemic were non-significant.

Conclusion: Elderly inpatients experience high levels of loneliness, especially those with a mental disorder. Interventions to reduce loneliness in this population should address predictors of loneliness, preferably through multiprofessional interventions.

Objective: Clinical street outreach programs serve people experiencing unsheltered homelessness, who have been shown to have greater medical and psychiatric comorbidities, and increased social and financial challenges. However, outreach programs may struggle in practice to engage the most vulnerable of these individuals.

Methods: Data from the Veterans Health Administration's (VHA's) Homeless Operations Management System (HOMES) from 2018 to 2019 (N = 101,998) were used to compare sociodemographic, clinical, and financial characteristics of literally homeless veterans contacted through street outreach to those who were self-referred or clinic-referred.

Results: Veterans engaged through street outreach reported substantially more days of unsheltered homelessness in the past month (mean (M) = 11.18 days, s.d.=13.8) than the clinic-referred group (M = 6.75 days, s.d.=11.1), and were more likely to have spent the past 30 days unsheltered (RR = 2.23). There were notably few other differences between the groups.

Conclusion: Despite epidemiologic evidence in the literature showing higher medical, psychiatric, and social and financial vulnerabilities among unsheltered homeless individuals, our street outreach group was not found to be any worse off on such variables than the clinic-referred or self-referred groups, other than increased time unsheltered. Outreach workers seem to engage more unsheltered individuals, but do not necessarily engage those with such severe vulnerabilities. Dedicated outreach program funding, training, and support are needed to support street outreach to those with the most severe problems.

Coercion in psychiatry is associated with several detrimental effects, including in the long term. The effect of past experience of coercion on the perception of subsequent hospitalisations remains less studied. The present study aimed to assess the impact of past experience of coercion on the perception of coercion and satisfaction with subsequent voluntary hospitalisations. A total of 140 patients who were hospitalised on a voluntary basis were included. Fifty-three patients experienced coercion before this hospitalisation and 87 did not. Patients were assessed for treatment satisfaction and perceived coercion. Health status was also evaluated by both patients and carers. Past experience of coercion was the independent variable. Perceived coercion and satisfaction scores were used as different dependent variables in a series of regression models. Results suggested a long-term detrimental impact of past experience of coercion on some aspects of satisfaction and perceived coercion in subsequent voluntary hospitalisations even when controlling for self and carers-rated health status. Overall, this study suggests that special attention should be paid to patients who are voluntarily admitted to hospital but have a history of coercion, as they may still be impacted by their past coercive experiences. Ways to increase satisfaction and reduce perceived coercion of these patients are discussed.