Psychiatric Rehabilitation Journal最新文献

Although a number of established practices are known to promote good outcomes for persons with psychiatric disabilities, significant challenges remain. As scholars and practitioners, we must work to ensure that psychiatric rehabilitative services are culturally relevant, accessible to the people who need them, and reflective of the needs and lived experiences of persons with psychiatric disabilities in today's context. Facilitating access to culturally relevant services involves conducting foundational research on the effectiveness and efficacy of established practices in diverse samples; tailoring existing services and developing new services to better meet the needs of diverse populations; and delivering such services in a manner that reduces health care disparities. Promoting service accessibility entails putting research findings into practice; ensuring that a trained workforce is available to provide services; and aligning policies and funding. Enhancing the relevance and impact of psychiatric rehabilitation services requires incorporating the perspectives of persons with lived experience across all phases of research and program delivery. The author's goal is for the research published in Psychiatric Rehabilitation Journal (PRJ) to address these critical issues. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: People living with severe and persistent mental illness (SPMI) in Kenya lack access to recovery-based services. In this study, we assessed changes in recovery in people living with SPMI in Kenya 6 months after receiving services at the Moi Teaching and Referral Hospital Nawiri Recovery and Skills Centre (Nawiri).

Methods: A retrospective evaluation was conducted using a pretest/posttest design analyzing Nawiri care program data collected on admission and 6 months after discharge for recovery metrics.

Results: Thirty patients, with an average age of 33 years and of whom 57% are female, met criteria for the study, with the most common mental diagnoses being schizophrenia (60%) and bipolar mood disorder (30%); 76% of participants met the definition of extreme poverty and had a median of two psychiatric admissions in the 12 months before admission. Patients improved significantly on recovery outcomes 6 months after receiving care at Nawiri, including decreased psychiatric hospitalizations (from 1.33 to 0.07), improved rates of independence in life skills (75.9%-96.7%), improved engagement in income generating activities (23.3%-63.3%), improved food security (69.0%-96.7%), decreased days of functional impairment from symptoms (3.7 to 1.7 days in past week), decreased substance use (53.3%-13.8%), and improved engagement in outpatient mental health care (50.0%-93.3%).

Conclusions and implications for practice: People living with SPMI had improved recovery 6 months after receiving residential psychiatric rehabilitation services in western Kenya. A more robust evaluation of program effectiveness and implementation is recommended to help explore generalizability and scalability to other resource limited settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Prior qualitative studies show that individuals with psychoticlike experiences express difficulties concerning their identity. However, previous work has studied individuals at clinical high risk for psychosis (CHR) and individuals with first-episode psychosis (FEP) separately. Here, we compare the experiences of individuals at CHR, individuals with FEP, and healthy individuals.

Methods: Participants included 70 individuals at CHR (57% female, M_age = 19.2 ± 3.0), 50 individuals with FEP (56% female, M_age = 20.4 ± 2.9), and 70 healthy individuals (67% female, M_age = 21.1 ± 2.8). Participants completed 30-45-min open-ended interviews. Trained research staff reviewed interview transcripts and conducted an iterative thematic analysis to identify major themes.

Results: Themes related to distress, social difficulties, trauma, gratitude, and communication were spontaneously described by both individuals at CHR and individuals with FEP, with individuals at CHR describing suspiciousness more than individuals with FEP (42% vs. 22%), χ²(1, 120) = 4.95, p = .03, and individuals with FEP discussing adaptive integration of mental health struggles into their identity more than individuals at CHR (56% vs. 36%), χ²(1, 120) = 4.87, p = .03. Healthy individuals endorsed future orientation more than individuals at CHR (69% vs. 49%), χ²(1, 140) = 5.77, p = .02, and individuals with FEP (69% vs. 48%) χ²(1, 120) = 5.14, p = .02. All groups endorsed essentialist beliefs: CHR (31%), FEP (43%), and healthy controls (44%).

Conclusions and implications for practice: Individuals at CHR and with FEP spontaneously discuss issues related to their identities in ways that are informed and shaped by the social milieu. The bidirectional nature of these struggles reinforces a need for integrated care through psychiatric rehabilitation, with a specific focus on identity development. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Longitudinal investigation of associations between personal and clinical recovery is important to understand how the relationship unfolds over time. This prospective study investigated associations between personal recovery and clinical symptoms, and personal recovery and psychosocial functioning, at baseline and 18-month follow-up, among service users with psychosis.

Method: Data were collected from 318 service users with psychosis and their clinicians from 32 clinical sites across Norway at baseline and after 18 months. Personal recovery was measured using the Questionnaire About the Process of Recovery. Linear mixed models with random intercepts for units were estimated to test the association between personal recovery and clinical symptoms, and personal recovery and psychosocial functioning.

Results: Greater severity of symptoms and lower level of functioning were associated with lower personal recovery assessed at both baseline and follow-up. Greater severity of symptoms and lower level of functioning measured at baseline predicted lower personal recovery at follow-up. In addition, personal recovery decreased over time for those with a greater severity of symptoms but increased over time for those with a high level of functioning.

Conclusions and implications for practice: Overall, this study confirms the relationship between clinical recovery and personal recovery. Both clinical symptoms and level of functioning were associated with personal recovery, indicating that both aspects are important for personal recovery. These findings suggest that it might be beneficial to support both clinical and personal recovery in the treatment of people with psychosis. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Personal recovery has become a guiding vision in mental health care, and peer workers play a key role in assisting individuals on their recovery journey. As a component of training to prepare for this role, peer workers need to engage with their own life story, in order to support recovery in both them and in the service users they will assist. The purpose of the present study was to explore the impact of life story work on peer workers.

Method: Fifteen individuals training to be peer workers were interviewed to explore the impact of telling and listening to life stories. Reflexive thematic analysis involving two analysts was conducted.

Results: Three main themes were identified: (a) life story work as identity reconstruction, (b) social connection through life story sharing, and (c) negative impacts of engaging with life stories in peer worker training. Each theme was connected to a number of subthemes.

Conclusions and implications for practice: Life story work can both facilitate personal recovery in peer workers during their training and aid them in utilizing their stories in their future peer worker roles. Training needs to prepare peer workers to deal with the future role-related challenges of life story work. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Persons who cope with serious mental illness (SMI) without immediate physical risk to themselves or others have the right to refuse to be treated. Treatment refusal has implications not only for the individual but also for the family, especially the primary caregivers. Still, less is known about the phenomenon of family burden while coping with a situation where the family member with SMI refuses treatment and lives in the community. The present study aimed to understand and describe the caregivers' lived experience of family burden in the context of treatment refusal among their relatives.

Methods: Using a descriptive phenomenological qualitative approach and a semi-structured interview guide, 15 family caregivers of persons with SMI refusing to receive medicinal treatment and rehabilitation services were interviewed. Inductive thematic analysis was conducted on the interview transcripts.

Results: The caregivers described a complex experience of ongoing and intense burden that had a negative impact on the family cohesion and the caregivers' well-being. Four themes related to the perceived reasons for treatment refusal, the caregivers' experience of the family burden and cohesion, and coping with this situation were identified.

Conclusions and implications for practice: The findings demonstrate the unique family burden experienced by the caregivers, mainly as they are the only ones supporting the individual with SMI who refuses treatment. Practitioners should support these families throughout their coping process-from understanding the reasons for the refusal of treatment to continuous support in their daily coping by locating the control of the situation on the family level. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Internalized stigma, a stigmatized view of oneself, is a prevalent issue in individuals with schizophrenia spectrum disorders (SSDs). Past evidence has suggested that internalized stigma may contribute to lower levels of functional recovery and lower engagement with mental health treatment in this population. The present study first involved a quantitative portion to check whether the current sample aligned with the literature regarding internalized stigma's links with functional recovery and treatment engagement. Then, a qualitative analysis examined participants' perceptions of whether and how their experiences with internalized stigma are related to their functional recovery and treatment engagement.

Methods: Adult participants in the United States (N = 29) with diagnoses of schizophrenia or schizoaffective disorder completed self-report quantitative measures of internalized stigma, treatment engagement, and functional recovery, and then, they answered open-ended written questions on their perspectives. Data were collected in the Years 2022-2023.

Results: Quantitative results indicate that internalized stigma was associated with lower functional recovery and lower treatment engagement, aligning with prior findings in the literature. Qualitative analysis of written responses revealed that many but not all participants perceive internalized stigma as impacting their functioning and treatment engagement. Themes are described in detail and involve relationship issues, difficulty leaving the house, self-doubt, and decreased engagement with treatment providers.

Conclusions and implications for practice: Internalized stigma is a prevalent issue with varying impacts on individuals with SSDs. This study highlights the importance of addressing internalized stigma and its consequences as a part of mental health treatment for individuals with SSDs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: The overall aim of this study was to elicit and document the recovery-related perspectives and experiences of Haredi Jews with lived experience of mental illness living in Canada. A more focused objective was to specifically explore self-identified facilitators and barriers toward recovery from mental illness in this group.

Methods: We conducted a qualitative study involving semistructured interviews with 20 women who (a) identified as Haredi Jews, (b) had used mental health services in recent years, and (c) were 18+ years of age. Interviews were transcribed and analyzed using thematic analysis techniques.

Results: Four prominent themes emerged from the analysis. The first two themes were predominantly facilitators, and the last two themes were predominantly barriers. These themes were (i) a close-knit, supportive, and lively community with considerable social capital; (ii) Judaic beliefs and practices regarding Gd, daily life, and health care giving structure, meaning, and purpose; (iii) community stigma and self-stigma, often related to marriageability of self or offspring, as well as notions of perfection; and (iv) a lack of wider mental health literacy, despite participants speaking positively about mental health services such as medication and therapy.

Conclusions and implications for practice: This study indicates several individual-level and community-level factors that are reported to facilitate recovery in Haredi Jews. However, problems of stigma and mental health literacy remain an issue. Targeted antistigma programs, such as co-constructed contact-based educational interventions, may be helpful in contributing to a community climate that further facilitates recovery. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Ikigai is a Japanese concept of a life worth living and related to eudaimonic well-being. Supporting the pursuit of ikigai is of central importance to recovery-oriented psychiatric rehabilitation for people with serious mental illnesses (SMI). While research suggests that work, leisure, and social relationships are potential sources of ikigai, people with SMI have restricted access to these as they encounter systemic barriers to participating in such activities. This study investigated how people with SMI in Japan pursued sources of ikigai in the face of barriers.

Methods: A total of 21 community-living individuals who had SMI and were recruited from community psychiatric rehabilitation service providers in Japan participated in the study. Photo-elicitation interviews were conducted, and the interview transcripts were analyzed using reflexive thematic analysis.

Results: Three themes were generated: (a) self-determination as a key to ikigai, (b) explorations needed to identify sources of ikigai, and (c) navigating the challenges to engage in the explorations. It was found that a self-determined activity tends to be a source of ikigai. However, participants had to grapple with challenges because identifying a source of ikigai involved the exploration of their personal interests, and the exploration could not be continued without managing the stigma of mental illness.

Conclusions and implications for practice: Results suggest that ikigai cannot be achieved instantly. To achieve eudaimonic well-being outcomes, psychiatric rehabilitation professionals should allow consumers to choose activities based on their personal interests and encourage them to try out various activities while they provide continued support to overcome stigma. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: This study explores the experiences of young adults with psychosis using a smartphone application to promote patient activation and support shared decision making in their outpatient treatment.

Method: Semistructured interviews were conducted with eight participants who had access to the app while receiving mental health treatment. Qualitative data from the interviews were analyzed using thematic analysis aimed at experiences of interacting with the app.

Results: Four themes were extracted from the interviews: supporting users with memory difficulties, giving symptoms substance, a new source of information to guide conversations, and the challenge of capturing complex experiences digitally. While the majority of the themes highlight the benefits of using the app in ways that may facilitate communication between patient and provider, the participants also described some negative experiences when interacting with the app concerning failure to communicate nuances and emotional states satisfyingly.

Conclusion and implications for practice: Experiences with the app were double sided. On the one hand, the use of the app supports communication, and conversely, interaction with the app can create limitations and new challenges for communication. There is a need for more research to understand the use of mental health smartphone apps and their role in supporting interactive processes such as shared decision making in mental health. (PsycInfo Database Record (c) 2025 APA, all rights reserved).