Journal of Mental Health最新文献

Background: Intimate and sexual feelings are common within psychotherapy, with negative outcomes when not managed adequately.

Aims: This study aims to investigate the understudied topic of these intimate and sexual feelings in basic education and psychotherapy training programs.

Method: In this convergent mixed method study, both a survey (N = 786) and 8 focus groups (N = 36) were conducted among psychotherapists in Flanders, Belgium (November 2016 - June 2018), using inferential and thematic analyses respectively.

Results: The majority indicates that dealing with intimate and sexual feelings towards clients was hardly part of either their basic education or psychotherapy training. Talking about such feelings with peers or supervisors remained difficult because of concerns about being judged. Therapists indicating this topic was addressed in some way in their training indicated more often that they did not perceive it as a taboo topic. Therapists advocated a more open discussion and reflection on this topic. Education and training, as well as support from renowned key figures in their field, were regarded as important incentives to initiate change.

Conclusion: Psychotherapy training should focus on how to deal with intimate and sexual feelings, referring to introspection and exploration of these feelings in a more integrated way during training.

Background: Trauma and posttraumatic stress disorder (PTSD) are common among individuals with serious mental illness (SMI; e.g., schizophrenia, schizoaffective disorder, bipolar disorder, treatment refractory major depressive disorder), with resultant functional impairment. Previous studies have not evaluated the factor structure of the PTSD Checklist (PCL) among persons with SMI.

Aims: This study evaluated the factor structure of the PCL in two large SMI samples from public mental health treatment sectors screened for PTSD using the PCL.

Methods: Four different models of PTSD were tested using confirmatory factor analyses.

Results: Results indicated that the DSM-5 4-factor model (intrusion, avoidance, numbing, and hyperarousal) had the best fit. Further, the DSM-5 4-factor model demonstrated measurement invariance.

Conclusions: Results supported the suitability of the DSM-5 4-factor model of PTSD among people with SMI.

Background: Self-harm behaviors (performed with either lethal and non-lethal intentions) are common, especially among individuals suffering from mood disorders, and the reasons individuals self-harm vary both by person and by the type of behavior. Understanding these variations may help clinicians determine levels of risk more accurately.

Aims: To understand whether culture and gender are associated with the likelihood of engaging in specific self-harm behaviors and whether the intention (lethal, ambivalent, non-lethal) of these behaviors vary with culture and gender.

Methods: 2826 individuals took part in an international multilingual online depression/suicidality screening study and reported at least one instance of self-harm in the past year. Participants were grouped into six broad cultural categories (Latin America, South Asia, Russian, Western English, Chinese, Arab).

Results: 3-way (culture x gender x intent) interactions were observed for several self-harm behaviors (overdosing, self-burning, asphyxiating, poisoning, and jumping from heights), suggesting that individuals engage in each of these behaviors with different intentions depending on gender and culture. Cultures and genders likewise differed in the likelihood of engaging in several self-harm behaviors.

Conclusions: Clinicians should consider culture and gender when assessing for suicide risk, as similar self-harming behaviors may reflect different intentions depending on an individual's culture and gender.

Background: Averting incidents of patient self-harm is an ongoing challenge in acute inpatient mental health settings. Novel technologies that do not require continuous human visual monitoring and that maintain patient privacy may support staff in managing patient safety and intervening proactively to prevent self-harm incidents.

Aim: To assess the effect of implementing a contact-free vision-based patient monitoring and management (VBPMM) system on the rate of bedroom self-harm incidents.

Methods: A mixed methods non-randomized controlled before-and-after evaluation was conducted over 24 months on one female and one male acute inpatient mental health ward with the VBPMM system. The rates of bedroom self-harm, and of bedroom ligatures specifically, before and after implementation were investigated using quantitative methods. Qualitative methods were also used to explore the perceived effectiveness of the system and its acceptability.

Results: A -44% relative percentage change in bedroom self-harm incidents and a -48% relative percentage change in bedroom ligatures incidents were observed in the observational wards with the VBPMM system. Staff and patient responses gave insights into system acceptability and the ways in which these reductions may have been achieved.

Conclusion: The results indicate that using the VBPMM system helped staff to reduce self-harm incidents, including ligatures, in bedrooms.

Background: This paper presents a scoping review of the peer-reviewed literature regarding reported risks, adverse effects and mitigation factors related to providing mental health services using telehealth.

Aims: The paper aims to describe risks and risk management strategies.

Methods: Publications were included if they reported upon risks, adverse events or mitigation factors experienced, hypothesised or discussed for: any population (any country, any age), service (any mental health services), intervention (telehealth), English language, 2010 to 10 July 2021, any publication type (commentary, research, policy), excluding protocol papers, and self-help tools. The following databases were searched: PsycINFO (from 2010 to 10 July 2021), MEDLINE (2010 to 10 July 2021) and the Cochrane Database from 2010 to 10 July 2021.

Results: The search strategy resulted in 1,497 papers and after exclusions a final 55 articles were selected. Results of this scoping review are presented in terms of types of risk, risk by client population, risk by modality (eg group therapy using telehealth) and risk management.

Conclusions: Recommendations for future research include gathering and publishing more detailed information regarding near-miss and actual adverse events when delivering mental health assessment and care using telehealth. In clinical practice, training is required for potential adverse events, and to prevent them and reporting mechanisms in place to collate and learn from these.

Background: Many anti-stigma programs for healthcare workers already exist however there is less research on the effectiveness of training in skills for health professionals to counter stigma and its impacts on patients.

Aims: The objective of this study was to examine the theory base, content, delivery, and outcomes of interventions for healthcare professionals which aim to equip them with knowledge and skills to aid patients to mitigate stigma and discrimination and their health impacts.

Methods: Five electronic databases and grey literature were searched. Data were screened by two independent reviewers, conflicts were discussed. Quality appraisal was realized using the ICROMS tool. A narrative synthesis was carried out.

Results: The final number of studies was 41. In terms of theory base, there are three strands - responsibility as part of the professional role, correction of wrongful practices, and collaboration with local communities. Content focusses either on specific groups experiencing health-related stigma or health advocacy in general.

Conclusions: Findings suggest programs should link definitions of stigma to the role of the professional. They should be developed following a situational analysis and include people with lived experience. Training should use interactive delivery methods. Evaluation should include follow-up times that allow examination of behavioural change. PROSPERO, ID: CRD42020212527.

Background: Self-harm amongst young people in the United Kingdom is higher than in other European countries. Young people who self-harm are often reluctant to seek professional help, turning increasingly to the internet for support, including online forums. There are concerns about misinformation or harmful content being shared, potentially leading to self-harm contagion. Moderation of online forums can reduce risks, improving forum safety. Moderation of self-harm content, however, is an under-researched area.

Aims: Using the Behaviour Change Wheel (BCW), this study examines the barriers and enablers to moderation of self-harm content and suggests behaviour change techniques (BCTs) to address barriers.

Method: Qualitative interviews with 8 moderators (of a total of 16) from the UK's leading young people's support service for under 25s, The Mix, were conducted.

Results: Thematic analysis identified eleven enablers, four barriers and one both an enabler and a barrier. Barriers included emotional exhaustion, working with partial information, access to timely support, vagueness within the guidelines and influence of community users. BCTs selected included increasing social support through a moderation buddy.

Conclusions: Optimisation strategies focus on increasing the support and level of information available to moderators and could be considered by other organisations providing similar services.

Background: Brief motivational coaching, integrated into health care; seems promising to address physical inactivity of people with serious mental illness (SMI).

Aims: To test the impact of a self-determined health coaching approach (the "SAMI" intervention) during outpatient mental health treatment on moderate-to-vigorous physical activity (MVPA) of people with SMI.

Methods: Adults (mean age = 41.9, SD = 10.9) with an ICD-10 diagnosis of mental illness were semi-randomized to the SAMI-intervention group (IG) or control group (CG). The IG received 30 minutes of health coaching based on the self-determination theory (SDT). MVPA and sedentary time (ST) were measured with the International Physical Activity Questionnaire - short form (IPAQ-SF) and symptoms of mental illness with the Brief Symptom Inventory (BSI-18), each at baseline and follow-up (3-4 months). Differences in primary (MVPA) and secondary (ST, BSI-18) outcomes were evaluated using negative binomial regressions and general linear models.

Results: In the IG (n = 30), MVPA increased from 278 (interquartile range [IQR] = 175-551) to 435 (IQR = 161-675) min/week compared to a decrease from 250 (IQR = 180-518) to 155 (IQR = 0-383) min/week in the CG (n = 26; adjusted relative difference at follow-up: Incidence Rate Ratio [IRR] = 2.14, 95% CI: 1.17-3.93, p = 0.014). There were no statistically significant differences in ST and BSI-18.

Conclusions: Brief self-determined health coaching during outpatient treatment could increase post-treatment MVPA in people with SMI, potentially up to a clinically relevant level. However, great uncertainty (for all outcomes) weakens the assessment of clinical relevance.

Background: Mental illnesses and mental health challenges have become increasingly pervasive among Chinese university students. However, the utilization rate of mental health services is low among students.

Aims: We aimed to explore Chinese university students' help-seeking behaviors to understand how they deal with mental health challenges and use the results to inform the development of effective mental health promotion initiatives.

Methods: In this study, we conducted 13 focus group interviews with students in six universities in Jinan, China, including 91 (62%) female students and 56 (38%) male students. We drew on the Theory of Planned Behaviors to guide our thematic analysis to gain a contextual understanding of participants' accounts on help-seeking.

Results: Our results have depicted the help-seeking patterns of Chinese university students and show that there are four major behaviors which are self-reliance, seeking support from peers and families, seeking professional support, and accessing virtual mental health care.

Conclusion: Results from this study can be used to inform the development of mental health literacy programming for students in universities that share similar contexts, and the study has also opened up a new space for using qualitative approaches to study mental health needs and access to care in diverse populations.