Psychiatric Rehabilitation Journal最新文献

Objective: We call for the psychiatric rehabilitation field to assess overpolicing as racialized trauma via a targeted universal trauma screening to provide trauma-informed rehabilitation services.

Methods: We examine the overpolicing of low-level, nonviolent activities and offenses through frequent stops, tickets, and arrests of disproportionately those who have mental health conditions and are Black, Indigenous, and people of color. These police interactions can produce traumatic responses and exacerbate symptoms. Assessing and responding to overpolicing is vital for psychiatric rehabilitation to provide trauma-informed services.

Results: We present preliminary practice data using an expanded trauma exposure form with racialized trauma, such as police harassment and brutality, that is absent from validated screenings. From this expanded screening, the majority of participants reported undisclosed racialized trauma.

Conclusions and implications for practice: We recommend the field devote practice and research to racialized trauma and policing and the lasting effects to support trauma-informed services. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: This study examines barriers and facilitators to participation in webSTAIR, a telemental health program providing virtual coaching sessions for veterans with posttraumatic stress disorder (PTSD) and depression symptoms, among women veterans from racial and ethnic minority groups.

Method: Using qualitative interviews (n = 26), we compared women veterans from racial and ethnic minority groups who completed (completers; n = 16) and did not complete (noncompleters; n = 11) webSTAIR at rural-serving facilities in the Veterans Health Administration (VA). Interview data were analyzed using rapid qualitative analysis. Chi-square and t tests assessed differences between completers and noncompleters by sociodemographic characteristics and baseline PTSD and depression symptomatology.

Results: There were no statistically significant sociodemographic differences at baseline between completers and noncompleters; completers reported significantly higher baseline PTSD and depression symptomatology. Noncompleters were more likely to describe feeling angry, depressed, and unable to control their environments during participation in the program as barriers to webSTAIR completion. Completers, despite higher symptomatology, cited internal motivation and support from concurrent mental health services as facilitators. Both groups made recommendations for how VA can better support women veterans from racial and ethnic minority groups, including providing space for peer support and community building, addressing stigma associated with seeking mental health services and fostering mental health provider diversity and retention.

Conclusions and implications for practice: Although previous research has identified racial and ethnic disparities in PTSD treatment retention, mechanisms to improve retention have been unclear. Women veterans from racial and ethnic minority groups should be collaboratively engaged in the design and implementation of telemental health programs for PTSD to improve equitable retention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: The aim of our study was to gain insight into how practitioners in mental health care support people with severe psychiatric disabilities in setting and pursuing personal goals that are meaningful to them.

Method: We conducted focus groups with 36 mental health practitioners in Norway and interpreted the data by using reflexive thematic analysis.

Results: Four themes emerged from the analysis: (a) active collaboration to understand what is meaningful to the individual, (b) being nonjudgmental during the process of goal setting, (c) helping individuals break goals into smaller goals and steps, and (d) allowing time for the process of trying to achieve goals.

Conclusions and implications for practice: Although goal setting is central to the Illness Management and Recovery program, practitioners perceive the work as quite demanding. To succeed, practitioners need to acknowledge goal setting as a long-lasting and shared process, not as a means to an end. As people with severe psychiatric disability often need help in goal setting, practitioners should play an important role in supporting them in setting goals, making plans for achieving them, and taking actual steps in that direction. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Stigma jeopardizes recovery and successful implementation of mental health services (MHS) globally. Despite cultural variation in how stigma manifests, few studies have examined how culture fundamentally impacts the concept of "personhood" in Latin America. Chile has expanded MHS, providing universal coverage for evaluation and treatment of first episode psychosis (FEP). We applied the "what matters most" (WMM) framework of stigma to identify culturally salient factors that shape or protect against stigma in urban Chile, identifying potential implications for MHS and recovery.

Methods: In-depth interviews (n = 48) were conducted with MHS users with psychotic disorders (n = 18), their family members (n = 15), and community members (n = 15), from two urban regions in Chile. Interviews were coded and analyzed to identify WMM, how WMM shapes stigma, and how MHS can influence achieving WMM.

Results: Traditional values emphasizing physical/social appearance, gender roles, family, and social connectedness are highly valued. Socioeconomic transitions have engendered capitalistic variations on traditional values, with increasing emphasis on professional careers for men and women, individualism, and independence. Psychotic disorders interfere with fulfillment of both traditional and capitalist values, thereby reinforcing stigma. However, MHS are seen as partially effective in enabling fulfillment of some goals, including employment, appearance, and independence, while often remaining insufficient in enabling capacity to achieve marriage and having a family.

Conclusions and implications for practice: MHS that facilitate recovery by engaging users in services, such as pharmacotherapy, education/vocational rehabilitation, and family-centered care aligned with cultural values can mitigate stigma and facilitate recovery by enabling users to fulfill WMM. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: This article examines the relationship between inpatient mental health units' adherence to recovery-oriented care and 30-day patient readmission.

Method: The sample included patients admitted to one of 34 Veterans Health Administration inpatient mental health units. Recovery-oriented care was assessed using interviews and site visits. Patient characteristics and readmission data were derived from administrative data.

Findings: Overall recovery orientation was not associated with readmission. Exploratory analyses found higher scores on a subsample of items pertaining to inpatient therapeutic programming were associated with lower patient readmissions. Additionally, patients with more prior service use and substance abuse or personality disorders were more likely to be readmitted.

Conclusions and implications for practice: A growing body of literature supports the association between psychotherapeutic services in inpatient units and better patient outcomes. However, further research is needed to examine this association. More work is needed to develop appropriate psychotherapy services for the inpatient setting and support their implementation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: To understand barriers and facilitators to engaging in community activities for increasing social connectedness among recently psychiatrically hospitalized veterans, a population at elevated risk for suicide.

Method: We completed 30 semistructured qualitative interviews with veterans within 1 week of discharge from inpatient psychiatric hospitalization. Our interviews focused on understanding past and current barriers, facilitators, and needs for engaging in community activities after psychiatric hospitalization. Data were analyzed using a modified grounded theory approach.

Results: Veterans shared feeling a lack of belonging and discussed several barriers to community engagement including lack of self-confidence, limited knowledge of opportunities, and negative expectations. Veterans identified several ways to facilitate engagement in community activities such as centralizing information on community activities and providing active support posthospitalization.

Conclusions and implications for practice: Veterans by and large valued community and the role of community activities for increasing social connectedness. However, more active intervention for supporting engagement in community activities appears necessary to facilitate connection posthospitalization. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Serious mental illnesses (SMI) often occur during early adulthood, just as young people are developing important aspects of their identity that can affect their recovery. Positive ethnic identity development is associated with stress coping and psychological well-being in young people. But, there is limited research to indicate how individual experiences of belonging and attachment to one's ethnic group influence personal recovery processes among young adults living with SMI.

Method: Young adults living with SMI (95% identified as ethnic/racial minorities) were recruited from four outpatient psychiatric rehabilitation programs (N = 83). Multivariate regressions were used to examine relationships between predictors (demographics, psychiatric symptomatology, ethnic identity) and the dependent variables (perceived stress and personal recovery).

Results: A stronger, more developed ethnic identity and fewer depressive symptoms were associated with higher ratings of personal recovery. Increases in psychiatric symptoms predicted increased perceived stress. Post hoc analyses showed that Black, Latino/a, and multiracial study participants' ethnic identity ratings were similar to those of same ethnic/racial group of young adults without SMI.

Conclusions and implications for practice: Ethnic identity development could be a significant psychosocial factor shaping mental health recovery among minority young people living with SMI. Several factors associated with psychological well-being among ethnic and racial minority youth may account for this, including adaptive coping, social support, and a buffering effect against racism. Our findings indicate that assessing and developing a young person's ethnic identity-related strengths and resources as a means for improving the personalization of recovery services and enhancing the quality of care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Service users commonly keep their mental illness secret in order to avoid rejection. However, this stigma-coping orientation is not necessarily effective and may lead to a number of negative psychological consequences. The purpose of the present study was to investigate the roles of various aspects of personal stigma in predicting secrecy about mental health problems among persons with psychosis.

Methods: A sample of 147 individuals diagnosed with psychotic disorders was recruited for the study. They were administered a set of questionnaires to gather data about sociodemographic and illness-related background characteristics, levels of social functioning, depressive symptoms, and overall psychopathology, elements of personal stigma (i.e., perceived stigma, experienced discrimination, self-stigma, and stigma-related stress), as well as the endorsement of secrecy as a way of coping with stigma. Hierarchical linear regression was utilized for data analysis.

Results: Personal stigma measures were entered into the regression equation as a block and explained as much as 29% of variance in the dependent variable over and above sociodemographic and clinical features. After accounting for all controls, higher perceived stigma (β = 0.47, p < .01) and higher stigma stress (β = 0.19, p < .05) were found to be independent predictors of secrecy, whereas experienced discrimination and self-stigma were not.

Conclusions and implications for practice: Perceived stigma and stigma stress appraisal should be considered as targets of interventions aiming to reduce the shame and fear of rejection associated with mental illness and to guide and support people's everyday decisions about coming out. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Individuals with serious mental illness (SMI) experience a 10-25-year reduced life expectancy when compared to the general population that is due, in part, to poor health behaviors. Yet, in spite of the development of health promotion and self-management interventions designed for people with SMI to promote health behavior change, the mortality gap has increased, suggesting that relevant factors are not being addressed. The objective of the present study was to explore potential contributors to early mortality among individuals with SMI by drawing from the lived experience of certified peer support specialists and service users (SUs).

Method: Face-to-face semistructured interviews were conducted with a convenience sample of SU participants (n = 17) and certified peer specialists (n = 15). Qualitative data were analyzed using a grounded-theory approach.

Results: We identified a final set of 27 codes relating to five overarching themes that relate to both risk factors and protective factors for early death: social connectedness (24.1% of coded items), treatment (21.3%), coping (21.3%), physical health and wellness (18.5%), and resilience and mental health (14.8%).

Conclusions and implications for practice: Findings add to the literature supporting the powerful role of social processes in shaping health in people with SMI beyond social determinants of health (SDOH; e.g., income, employment) and health behavior change. Interventions that reduce loneliness and isolation in combination with addressing more conventional SDOH may have the most potential to reduce early mortality in people with SMI. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Young adults experiencing a first episode of psychosis (FEP) have high rates of cannabis use and cannabis use disorder (CUD). No evidence-based practice effectively treats CUD for people with FEP, and little is known about factors that influence intentions to reduce or stop using. A critical inquiry was conducted to identify salient factors contributing to intentions of young adults with FEP to reduce or discontinue cannabis use, guided by theory of planned behavior (TPB).

Method: Online focus groups (n = 3) and individual interviews (n = 3) were conducted with 16 young adults with FEP (mean age of 23.7) and historical cannabis use (averaging 11.8 days of use in the previous 30). A content analysis was conducted to sort data into TPB constructs, and a thematic analysis was subsequently performed to identify the breadth of themes.

Results: Participants identified benefits of cannabis reduction and cessation for pursuing life goals, but most maintained regular use. Participants perceived cannabis as a facilitator of social interactions, enjoyable activities, and improved mental health (and reduced dysthymia). Many were concerned about reducing or discontinuing cannabis without replacement strategies to compensate for its benefits.

Conclusions and implications for practice: In spite of life goals incompatible with cannabis use, cessation was not favored given the perceived benefits of cannabis and participants' lack of replacement strategies to facilitate social interactions, enjoyable activities, and euthymia. Interventions may be improved by addressing motivations for use and by teaching skills to build positive social support, schedule enjoyable activities, and ameliorate dysthymia. (PsycInfo Database Record (c) 2023 APA, all rights reserved).