Journal of Mental Health最新文献

Background: Anxiety symptoms and disorders are common in the UK. Whilst waiting for, or alongside, treatments such as anxiolytics or psychological therapies, people often self-manage anxiety symptoms with products purchased over-the-counter (OTC), such as herbal medicines or dietary supplements. However, the evidence for these products is often presented across different reviews and is not easy for patients or healthcare professionals to compare and understand.

Aims: To determine the nature and size of the evidence base available for these products.

Methods: A scoping review. CENTRAL, MEDLINE, EMBASE, PsycInfo, and AMED (inception-Dec 2022) were searched for RCTs assessing OTC products in people aged 18-60 with symptoms or a diagnosis of anxiety.

Results: In total 69 papers assessing a range of products were found, which mostly focussed on kava, lavender, saffron, probiotics, Galphimia glauca and valerian. Studies used varying dosages. Compared to herbal medicine studies, there were much fewer dietary supplement studies and homeopathic remedy studies, despite some of use of these by the general public.

Conclusion: Future research needs to investigate commonly used but less evaluated products (e.g. chamomile, St John's Wort) and to evaluate products against or alongside conventional treatments to better reflect patient decision making.

Background: Caregivers often report high stress levels, which may be associated with adverse mental health. Less is known about adult sexual and gender minority (SGM) caregivers' experienced stress and/or mental health considering they are likely at increased vulnerability to these outcomes due to social stigma, familial estrangement, and discrimination.

Aims: We tested relationships between caregiving and adverse mental health and if these associations were modified by SGM identity.

Methods: Using 2023 national BRFSS data (n = 32,151) we examined relationships between caregiving and two outcomes: depression and 14+ days with poor mental health, testing effect modification by SGM identity. Regression analyses, using both SGM and caregiving cross-categories and interaction term models were also conducted.

Results: Compared to heterosexual non-caregivers, both caregiving and SGM status were associated with greater depression and having 14+ days of poor mental health, with the highest prevalence of depression among transgender caregivers (aPR = 4.05, CI 3.03-5.00), transgender non-caregivers (aPR = 2.80, CI 2.24-3.25), and cisgender gay caregivers (aPR = 2.52, CI 2.01-2.93). Transgender and cisgender gay and bisexual caregivers also had the highest days with poor mental health. Additionally, interaction term models identified effect modification.

Conclusions: Disproportionate adverse mental health outcomes exist among caregivers, modified by SGM status. Longitudinal research is needed to understand these mechanisms and related outcomes including substance use and suicidality.

Background: In Canada, more than 4,500 people die by suicide annually, with individuals diagnosed with psychotic disorders being at significantly higher risk. Although the risk factors for suicide in this population are well-established, the assessment of suicide risk remains underexplored.

Aim: This study examines the practices of mental health professionals working with clients with a psychotic disorder in relation to suicide risk assessment, using the Theory of Planned Behavior (TPB) as a theoretical framework.

Method: A survey of 148 professionals across Canada was conducted to assess factors influencing the frequency and thoroughness of suicide risk assessments.

Results: Despite our perceived behavioral control scale having psychometrical flaws, results revealed that social norms were a significant predictor of systematic suicide risk assessments. Professionals identified a lack of time, training, and inadequate clinical tools as major obstacles to thorough assessments. Despite the widespread availability of suicide risk assessment training, many professionals did not feel adequately prepared or confident in conducting such assessments, particularly with clients with a psychotic disorder.

Conclusion: The findings highlight the need for enhanced support, training, and organizational changes to improve the systematic assessment of suicide risk in this vulnerable population.

Background: Complex PTSD (CPTSD) is often associated with prolonged or repeated trauma exposure and the experience of intimate partner and childhood abuse. CPTSD includes the criteria for PTSD (re-experiencing, avoidance, and sense of threat) in addition to three criteria for self-organization disturbances (affective dysregulation, negative self-concept, and relational disturbance).

Methods: This study aimed to assess profiles of CPTSD symptoms and their association with psychiatric distress among people with co-occurring Serious Mental Illness (SMI; schizophrenia/schizoaffective, bipolar, and treatment-refractory major depression). Treatment-seeking participants (N = 307) with SMI and PTSD diagnoses were drawn from two randomized controlled trials. Distinct symptom profiles were assessed using Latent Profile Analysis (LPA).

Results: A model with three classes best fit the data with the most parsimonious interpretation: 26.7% (n = 82) in the PTSD class, 43.7% (n = 134) in the CPTSD class, and 29.6% (n = 91) in the CPTSD+ Borderline Personality Disorder (BPD) class. The CPTSD+BPD class showed the highest levels of psychiatric symptoms, followed by the CPTSD and PTSD groups, respectively.

Conclusions: The results demonstrate the heterogeneity in symptom presentation across the PTSD classes and that, despite similar diagnoses, individuals may present with varying symptom patterns. This emphasizes the importance of studying CPTSD in subpopulations of persons with SMI.

Objectives: In evaluating the effectiveness of different therapeutic methods aimed at fostering post-traumatic growth (PTG) in individuals who have experienced trauma, a key inquiry arises: Can cognitive-behavioral therapies enhance PTG in those suffering from post-traumatic stress disorder?

Methods: To address this question, comprehensive searches were conducted across the PubMed, Web of Science, and Scopus databases from the inception of these databases through 1 January, 2025. To be included, studies had to consist of clinical trials, randomized controlled trials, quasi-experimental, or experimental methodologies that applied cognitive-behavioral therapy to enhance post-traumatic growth among individuals suffering from PTSD. Each study was qualitatively assessed using the Verhegen quality assessment checklist.

Results: The results showed that seven articles fulfilled the inclusion criteria, representing a total of 249 individuals and 46 couples, with a gender distribution of 47 males and 164 females. The findings of the study indicated that cognitive behavioral therapies lead to a notable enhancement in post-traumatic growth signs within the intervention group (SMD=-0.81, 95% CI=-1.19, -0.43, p=0.027). Furthermore, as the sample size in the studies increased, the impact of CBT on PTG improvement also grew (P=0.056).

Conclusions: It can be concluded that CBT-related interventions can assist individuals in achieving growth by engaging with and addressing crises.

Background: Family/informal carers play important roles in supporting or monitoring medicine-taking for people with recurrent psychosis, but their views on antipsychotic medication are under-researched.

Aim: To explore family/informal carers' views and experiences of antipsychotic reduction and discontinuation within a medication reduction research trial (Research into Antipsychotic Discontinuation And Reduction [RADAR]).

Method: Semi-structured interviews with 15 family/informal carers of participants in the antipsychotic reduction/discontinuation arm of RADAR who had completed the trial up to one year previously. Data were analysed using thematic analysis.

Results: Most carers observed improvements in social engagement, daily functioning or identity, and challenges related to mental health over the 24-month reduction period. Carers described a general state of vigilance that was heightened during the trial, and often felt they were better at detecting warning signs of deterioration than clinicians. Carers' views did not necessarily reflect their loved ones' relapse status. Many wished they had been more involved in the trial. Some expressed cautious optimism for future reductions, although complete discontinuation was generally deemed less viable.

Conclusions: Carers' perspectives on antipsychotic reductions within the RADAR trial complement main trial findings and explorations of service users' experiences. Clinicians should endeavour to include carers in decisions about, monitoring and support of changes or reductions to antipsychotics.

Background: The week following discharge from inpatient psychiatry is a time of exponentially increased risk of death by suicide among people diagnosed with a mental illness. Yet, a significant number of individuals do not receive timely outpatient follow-up upon being discharged from hospital. Psychosocial interventions that target suicidality initiated within inpatient psychiatry may help to prepare individuals for this vulnerable transition.

Aims: To explore the range and nature of research on psychosocial interventions targeting suicidality in the context of inpatient psychiatry and to identify the components and intended mechanisms of studied interventions as well as their mode and dose of delivery, adaptations, outcomes measured, and overall results.

Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and in line with the Preferred Reporting for Systematic Reviews and Meta-Analyses extension for Scoping reviews. Studies that described psychosocial interventions initiated in adult psychiatric inpatient units aimed at addressing suicidality were included.

Results: A total of 77 articles were included in the review, most of which employed quantitative research methods, were published after 2019, and were conducted in the United States. Most interventions studied were based on cognitive behavioral approaches, incorporated a review of factors that led to a person's suicidality, strategies for managing emotions, and safety planning. Participants' narratives as to what was helpful for them centred around the themes of being acknowledged, being listened to, and increasing self-awareness.

Conclusions: Cognitive behavioral therapy underlies most interventions targeting suicidality in inpatient psychiatry. There is a need for research that explores patients' experiences of engaging in specific suicide targeted interventions and that sheds light on the relational aspect of interventions targeting suicidality.

Background: The Emergency Department (ED) is a key setting for suicide risk assessments. In the UK, mental health professionals (MHPs) in psychiatry liaison teams assess suicide risk.

Aim: This study aimed to explore how MHPs in EDs experience and approach the assessment of suicide risk for people presenting for suicidal ideation and/or self-harm.

Methods: We interviewed 22 MHPs from one hospital (England) on their views of conducting psychosocial assessments. Interviews were recorded, transcribed and analysed using inductive thematic analysis.

Results: MHPs described various challenges, summarised in four main areas: the complexity of assessing suicide risk and lack of confidence in some patients/ accounts, the dynamic nature of risk, the impact/barrier of a structured assessment form, and institutional pressures and lack of resources. We identified views and attitudes that delegitimise patients. While such practices at an individual level need to be addressed, we posit this reflects organisational pressures that stifle practitioners' ability to prioritise therapeutic alliance.

Conclusions: It is unsurprising that MHP experience moral injury that can be manifested as amplify biases and compassion fatigue. This calls for changes to support staff striving to make assessments therapeutic and we recommend both top-down and bottom-up initiatives to improve the experiences of MHPs and their patients.

Background: Criminalization of people experiencing mental illness is systemic, but the conditions surrounding police use-of-force in such encounters are under-examined.

Aims: To describe mental or behavioral health (MBH) involvement in injurious shootings by U.S. police compared with MBH-uninvolved shootings.

Methods: Using a 2015-2020 dataset developed from manual review of injurious shootings by police compiled from the Gun Violence Archive (GVA) (n = 10,615), we identified 2454 people shot in MBH-involved encounters. Through further review, we classified the MBH conditions and behaviors involved. Using descriptive statistics and logistic regression models, we compared characteristics of injured people, presenting conditions, and responses.

Results: Twenty-three percent of injurious shootings by police involved MBH symptoms (n = 2336) or substance use (n = 921). Eighty-one percent of injured people threatened violence against others; 10% presented only self-harming symptoms, and 5% presented no symptoms. MBH involvement was associated with 1.5-times higher odds of fatality than MBH-uninvolved shootings and 31% higher odds of injuring an unarmed person vs. person with a gun. Clinician presence was identified in 1% of MBH-involved shootings.

Conclusions: Police are de facto mental health system responders. Associated harms may be reduced through triage systems to facilitate clinician involvement, extreme risk protection order statutes, and better police training and protocols.