Journal of Mental Health最新文献

Background: We examined the association between mode of birth (caesarean section (CS) vs spontaneous vaginal birth (SVB)) and the risk of postpartum depression (PPD) and explored mechanisms of this relationship.

Methods: We carried out a mixed-method, cross-sectional study in Ho, Ghana, among postpartum women. We used a binomial log-link generalised linear model to examine the association between birth mode and PPD risk. We applied a potential-outcome framework to test if negative childbirth experience or low self-esteem mediated this association. Additionally, we conducted in-depth interviews (IDIs) with mothers at risk of PPD.

Results: Among 399 mothers, CS was associated with a 68% higher prevalence of screen-positive PPD compared with SVB [adjusted prevalence ratio = 1.68 (95% CI; 1.22, 2.32); p = 0.002]. Neither childbirth experience nor self-esteem mediated this association. In the qualitative analysis of 19 IDIs, we identified three themes increasing PPD risk: delayed physical recovery from post-surgical challenges; emotional trauma, unmet expectations, and anxiety about future pregnancies; and experiences of social isolation coupled with financial strain.

Conclusion: Screen-positive PPD was common after both SVD and CS, and the association with CS persisted after adjustment for measured confounders. Universal postpartum screening and stepped psychosocial support, with enhanced recovery care for CS, may reduce burden.

Background: Artificial intelligence (AI)-powered cognitive behavioral therapy (CBT) tools show promise for anxiety and stress management, but patient perspectives remain poorly understood.

Aims: To synthesize qualitative evidence on patient experiences, attitudes, and preferences regarding AI-powered CBT tools for anxiety and stress management.

Methods: Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching eight databases through March 2025. Qualitative studies exploring patient perspectives on AI-powered CBT interventions were included. Thematic synthesis was employed with GRADE-CERQual confidence assessment.

Results: Nine studies (n = 600+ participants) from nine countries were included. Six major themes emerged: (1) Perceived benefits and therapeutic value, including enhanced self-awareness and 24/7 accessibility; (2) Technical limitations and personalization challenges; (3) Trust, privacy, and acceptability concerns; (4) User preferences for conversational interfaces and human-AI integration; (5) Facilitators and barriers to engagement; and (6) Cultural and demographic influences on user experiences. Users consistently viewed AI tools as supplements to human therapy.

Conclusions: AI-powered CBT tools provide accessible, non-judgmental support and practical coping strategies. However, technical limitations and personalization gaps remain significant challenges. Future development should enhance conversational capabilities, cultural adaptation, and integration with traditional care. Limitations of this study include English-language restriction, heterogeneity of AI interventions, and limited evidence for specific populations such as older adults.

Background: Actively engaging clients in managing their health and care is crucial for person-centered mental healthcare. Self-monitoring tools such as the Experience Sampling Method (ESM) can help individuals collect information about their mental health and daily activities on their smartphones and share this with their clinicians.

Aims: This qualitative paper examines how ESM self-monitoring might enhance self-insight, self-management, self-efficacy, therapeutic alliance, and shared decision-making and this way facilitate the activation of clients in mental healthcare.

Methods: Twelve clinicians and 24 clients participated in the IMPROVE study. After using the IMPROVE ESM self-monitoring tool, seven clinicians and 11 clients were interviewed, and a thematic analysis examined participants' experiences of changes in processes related to client activation.

Results: Clients reported improvements in self-awareness, self-insight, and self-management. Only a few participants experienced enhanced self-efficacy, improved therapeutic alliances, and more client involvement. Self-awareness was mainly boosted via smartphone self-monitoring, while collaborative data interpretation between clients and clinicians was crucial for unlocking insights about clients' mental health and creating actionable therapy goals.

Conclusion: Our findings suggest that using ESM self-monitoring tools can help facilitate the activation of clients in mental healthcare. Future research should develop best practice guidelines for integrating these tools into clinical care.

Background: Linguistic analysis, notably using conceptually derived linguistic categories, has been used to quantify various aspects of serious mental illness. It has the potential for understanding paranoia, defined in terms of perceived and intentional threats from others. However, paranoia and the language expressing it potentially varies due to demographic factors, notably race and sex.

Aims: This study aims to expand upon prior findings linking linguistic expression and serious mental illness symptoms by focusing on paranoia and evaluating potential moderating roles of race and sex in two archived studies using two separate speaking tasks.

Methods: We hypothesized that a limited feature set of linguistic categories derived from these speaking tasks would accurately classify clinical ratings of paranoia using regularized regression. It was further hypothesized that these relationships would vary as a function of Black versus White and male versus female identities.

Results: Unexpectedly, there were no differences in model accuracy as a function of race and sex, suggesting no overt bias or differential functioning from demographics in our models.

Conclusions: Results highlight the strengths and limitations of using linguistic analysis to understand paranoia. Exploring variation amongst paranoia scoring could improve model accuracy across different demographic groups.

Background: People with serious mental illness (SMI) and those who have experienced homelessness have disrupted social functioning. A primary obstacle to successful social functioning is building and maintaining meaningful social connections, which may depend on individuals' motivation to engage in social interactions.

Aims: We examined the temporal, bidirectional relationships between social approach and avoidance motivation and social interactions over time using ecological momentary assessment (EMA).

Methods: Twenty-nine participants with SMI and a history of homelessness answered EMA surveys of momentary social interaction, social approach motivation, and social avoidance motivation for seven days. The temporal relationships between these variables were analyzed as a dynamical system using continuous-time vector auto-regressive models.

Results: Three main findings emerged. First, social approach motivation positively influenced future social interactions more than social avoidance motivation. Second, social avoidance motivation also led to more future social interactions. Third, the number of social interactions positively influenced both social approach and avoidance motivation, with a slightly larger effect on social approach.

Conclusions: The current study highlights the utility of examining social motivation and social interactions as a dynamical system, which could be useful for better understanding impairments in social functioning. Possibilities for interventions are also discussed.

Background: Despite increasing global awareness of mental health and illness, individuals with mental illnesses still experience stigma in many African countries. This stigma can be pervasive and evolving, which can negatively impact care and quality of life.

Aims: This study aims to present a comprehensive overview of the prevalence, experiences, and consequences of mental illness stigmatisation in African countries, and offer recommendations for addressing this issue.

Methods: A systematic review of qualitative studies investigating mental health stigma was conducted, involving a thorough search of seven databases-APA PsycINFO, CINAHL, MEDLINE, APA PsycArticles, African Index Medicus (AIM), ScienceDirect, and Embase-for studies published between 2013 and 2023.

Results: Thematic analysis of 28 studies identified five main themes (prevalence of stigma, types of stigma, causes of stigma, experiences of stigma, and impacts of stigma) and seven subthemes.

Conclusion: Providing support to mental health service users and their families, as well as implementing policies and strategies to reduce mental health stigma, is crucial to minimising the prevalence and impact of mental health stigma.

Background: Insight into the assessment of patient-reported outcomes among adults with depression can help to understand their perception of their mental health and care experience.

Aims: To identify studies on the use of Patient-reported Outcome Measures (PROMs) and Patient-reported Experience Measures (PREMs) in the clinical care of depression.

Methods: A narrative review was conducted. PubMed and Scopus databases were searched for studies using patient-reported outcomes among people with depression.

Results: Several disease-specific and generic PROMs are available to assess the perceived symptoms severity and functioning. The use of PREMs is instead mostly limited to assessing satisfaction with care. There are also a series of psychometric and content limitations that hinder the reliability of such measures in the clinical management of depression.

Conclusions: There is a variety of patient-reported outcomes of relevance among adults with depression. Despite the growing interest regarding such outcomes and their measures, several methodological issues should be considered. Moreover, significant aspects of functional recovery of relevance for people living with depression do not appear to be completely covered by currently available measures.

Background: Contacts with primary care for early psychosis are common, and there is a need for further insight into help-seeking patterns.

Aims: We sought to describe the help-seeking experiences in primary care for people with early psychosis and their caregivers.

Methods: Using a qualitative descriptive approach, we recruited 22 clients with first-episode psychosis and 13 caregivers from seven specialized clinics to participate in a semi-structured interview. Interviews were audio recorded, transcribed, and coded thematically using conventional content analysis.

Results: Help-seeking experiences in primary care were varied. We identified themes describing client- and caregiver-level challenges and supports: impaired mental state, help-seeking decisions and support, and conflicting cultural beliefs and values (between clients and physicians). We also identified physician-level challenges and supports: physician knowledge (perceived as adequate or inadequate), follow-up (close or lack thereof), and supportive relationship with the client and/or caregiver. Finally, we identified health system-level themes: appointment availability and virtual care (described as insufficient).

Conclusions: Interventions to increase help-seeking for early psychosis more broadly may facilitate earlier primary care help-seeking. Primary care physician education, closer follow-up of young people with mental health issues, timely access, and in-person care could improve pathways to care in early psychosis.

Background: Assertive outreach (AO) is a systematic approach to engage vulnerable patients with serious mental illness.

Aims: This review aims to provide a comprehensive analysis of engagement strategies in relation to principles of the AO model to clarify effective components of AO, better understand engagement in an AO context, and consider encompassing change mechanisms.

Methods: A systematic mixed-methods review was completed from 1806 to December 2022 (no pre-registration). Articles meeting the inclusion criteria were rated for methodological quality using the JBI scales and thematic synthesis using a meta-aggregative approach. Reporting was according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement.

Results: Eighteen articles met the inclusion criteria. The literature was defined by three main themes: definition and perspectives of engagement; key principles of AO in relation to engagement; and additional principles and strategies enhancing engagement.

Conclusion: Despite the heterogeneity in defining engagement, the relationship between AO professionals and patients emerged as crucial in the process of engagement. Subsequently, the four key principles of AO emerged as central to promoting engagement. Finally, we identified a number of additional principles that are considered crucial in the engagement process in AO. The review concludes with recommendations for future research and the implementation of AO in routine clinical care.