Pub Date : 2025-10-30DOI: 10.1016/j.ssmmh.2025.100557
Catherine E. Draper , Claire Hart , Nosibusiso Tshetu , Nokuthula Nkosi , Stephen J. Lye , Shane A. Norris
This qualitative study explored how mature defence mechanisms support positive deviance in health and wellbeing among young women facing adversity in Soweto, South Africa. Drawing from the Bukhali randomized controlled trial in Soweto, which targets improved health trajectories for young women, this study focused on a group of participants who exhibited positive deviance in the trial by being employed or studying, engaging actively in the trial, and showing favourable physical and mental health indicators despite living in a context marked by poverty, inequality, and trauma. Eight in-depth interviews were conducted with participants who met selection criteria, and data were analysed using a codebook thematic approach, incorporating a psychoanalytic framework of defensive functioning. Participants demonstrated frequent use of high adaptive defences, such as anticipation, self-observation, sublimation, and self-assertion, which enabled emotional regulation, agency, and healthy coping. Self-isolation and low affiliation, often seen as withdrawal, were reframed as protective strategies when balanced with meaningful social connections. These findings offer a psychologically rich understanding of how young women in challenging environments navigate complex social landscapes. By integrating positive deviance with defensive functioning, the study extends psychoanalytic theory to marginalized contexts, revealing how mature defence mechanisms contribute to resilience. The insights have implications for designing strength-based mental health interventions tailored to the realities and psychological capacities of marginalized populations.
{"title":"The role of defensive functioning in positive deviance in psychological wellbeing amongst young women living in Soweto, South Africa","authors":"Catherine E. Draper , Claire Hart , Nosibusiso Tshetu , Nokuthula Nkosi , Stephen J. Lye , Shane A. Norris","doi":"10.1016/j.ssmmh.2025.100557","DOIUrl":"10.1016/j.ssmmh.2025.100557","url":null,"abstract":"<div><div>This qualitative study explored how mature defence mechanisms support positive deviance in health and wellbeing among young women facing adversity in Soweto, South Africa. Drawing from the <em>Bukhali</em> randomized controlled trial in Soweto, which targets improved health trajectories for young women, this study focused on a group of participants who exhibited positive deviance in the trial by being employed or studying, engaging actively in the trial, and showing favourable physical and mental health indicators despite living in a context marked by poverty, inequality, and trauma. Eight in-depth interviews were conducted with participants who met selection criteria, and data were analysed using a codebook thematic approach, incorporating a psychoanalytic framework of defensive functioning. Participants demonstrated frequent use of high adaptive defences, such as anticipation, self-observation, sublimation, and self-assertion, which enabled emotional regulation, agency, and healthy coping. Self-isolation and low affiliation, often seen as withdrawal, were reframed as protective strategies when balanced with meaningful social connections. These findings offer a psychologically rich understanding of how young women in challenging environments navigate complex social landscapes. By integrating positive deviance with defensive functioning, the study extends psychoanalytic theory to marginalized contexts, revealing how mature defence mechanisms contribute to resilience. The insights have implications for designing strength-based mental health interventions tailored to the realities and psychological capacities of marginalized populations.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100557"},"PeriodicalIF":2.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-28DOI: 10.1016/j.ssmmh.2025.100552
Toshiaki Komura , P. Richard Hahn , Kosuke Inoue
Background
Although previous studies have reported interpersonal associations between cardiovascular disease (CVD) and depression, evidence is lacking as to whether this association varies by individual characteristics.
Methods
Using a nationwide database, we applied a sequential matching framework to construct a cohort of 59,900 index individuals (primary insured) whose spouses (dependent) received first CVD diagnosis and those without spouses’ CVD event between 2016 and 2018. We examined heterogeneity in the association between spousal CVD events and subsequent depression in index individuals within 3 years via a novel machine learning approach, Bayesian causal forest (BCF), adjusting for sociodemographic characteristics, comorbidities, health behaviors, and physical health conditions. We trained the BCF model using randomly selected 50 % sample and evaluated the heterogeneity by estimating conditional average treatment effect (CATE) using the remaining 50 % sample.
Results
Our BCF algorithm identified heterogeneity in the association between spouse's CVD and depression (the lowest quartile of CATE [most resilient group], risk difference [95 %CI] = −0.54 percentage point [-1.24, 0.16] and odds ratio [95 %CI] = 0.78 [0.57, 1.07]; and the highest quartile of CATE [most vulnerable group], risk difference [95 %CI] = +0.73 percentage point [0.02, 1.44] and odds ratio [95 %CI] = 1.38 [1.01, 1.88]). Individuals with higher CATEs were more likely to have a higher proportion of females, have fewer disease histories, and have more frequent unhealthy behaviors. Most individuals were male (95 %), potentially limiting the generalizability.
Conclusions
The depression risk associated with spouse's CVD varied across individuals. Future studies should elaborate on building targeted interventions to promote better health security of family members as well as patients with CVD.
{"title":"Heterogeneity in the depression risk associated with spousal cardiovascular events","authors":"Toshiaki Komura , P. Richard Hahn , Kosuke Inoue","doi":"10.1016/j.ssmmh.2025.100552","DOIUrl":"10.1016/j.ssmmh.2025.100552","url":null,"abstract":"<div><h3>Background</h3><div>Although previous studies have reported interpersonal associations between cardiovascular disease (CVD) and depression, evidence is lacking as to whether this association varies by individual characteristics.</div></div><div><h3>Methods</h3><div>Using a nationwide database, we applied a sequential matching framework to construct a cohort of 59,900 index individuals (primary insured) whose spouses (dependent) received first CVD diagnosis and those without spouses’ CVD event between 2016 and 2018. We examined heterogeneity in the association between spousal CVD events and subsequent depression in index individuals within 3 years via a novel machine learning approach, Bayesian causal forest (BCF), adjusting for sociodemographic characteristics, comorbidities, health behaviors, and physical health conditions. We trained the BCF model using randomly selected 50 % sample and evaluated the heterogeneity by estimating conditional average treatment effect (CATE) using the remaining 50 % sample.</div></div><div><h3>Results</h3><div>Our BCF algorithm identified heterogeneity in the association between spouse's CVD and depression (the lowest quartile of CATE [most resilient group], risk difference [95 %CI] = −0.54 percentage point [-1.24, 0.16] and odds ratio [95 %CI] = 0.78 [0.57, 1.07]; and the highest quartile of CATE [most vulnerable group], risk difference [95 %CI] = +0.73 percentage point [0.02, 1.44] and odds ratio [95 %CI] = 1.38 [1.01, 1.88]). Individuals with higher CATEs were more likely to have a higher proportion of females, have fewer disease histories, and have more frequent unhealthy behaviors. Most individuals were male (95 %), potentially limiting the generalizability.</div></div><div><h3>Conclusions</h3><div>The depression risk associated with spouse's CVD varied across individuals. Future studies should elaborate on building targeted interventions to promote better health security of family members as well as patients with CVD.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100552"},"PeriodicalIF":2.6,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite dyadic interdependence of preparedness for death, associations of death preparedness (conjoint cognitive prognostic awareness and emotional acceptance) with psychological distress and quality of life (QOL) have been mainly examined cross-sectionally in patients or caregivers. This study longitudinally assessed associations of patient-caregiver concordance on death preparedness with dyads' psychological distress, QOL, and caregivers’ burden.
Patients/methods
Among 520 Taiwanese terminal cancer dyads, multivariate hierarchical linear models examined associations between death-preparedness concordance and anxiety, depression, QOL, and caregiving burden, separately for patients and caregivers across four concordant states (unprepared-concordant, cognitive-concordant, emotional-concordant, and sufficient-concordant) versus discordance, reported as β estimates with 95 % confidence intervals.
Results
Death-preparedness concordance was associated with outcomes, except unprepared concordance showed no association with patient outcomes, and emotional concordance was unrelated to caregiver outcomes. Relative to the discordant group, patients in the cognitive-concordant state had more anxiety (0.927 [0.364, 1.490]) and worse QOL (−3.933 [-6.661, −1.205]), whereas those in the emotional-concordant state had fewer symptoms of anxiety (−1.913 [-3.154, −0.672]) and depression (−1.617 [-3.128, −0.106]). The sufficient-concordant state was associated with fewer anxiety symptoms (−0.940 [-1.471, −0.409]) and better QOL (4.119 [1.252, 6.986]). Caregivers in unprepared- and cognitive-concordant states had more depressive symptoms and worse QOL, while those in the sufficient-concordant state reported fewer depressive symptoms (−1.960 [-3.348, −0.572]) and better QOL (3.922 [1.419, 6.425]). Cognitive-concordant caregivers also reported higher subjective burden (2.228 [0.962, 3.494]).
Conclusions
Sufficient concordance in death preparedness reduces patient anxiety and caregiver depression while improving dyads’ QOL, underscoring its role in enhancing end-of-life outcomes.
{"title":"Associations of Taiwanese patient-caregiver concordance on death preparedness with dyadic end-of-life outcomes","authors":"Fur-Hsing Wen , Chia-Hsun Hsieh , Wen-Chi Chou , Jen-Shi Chen , Wen-Cheng Chang , Siew Tzuh Tang","doi":"10.1016/j.ssmmh.2025.100553","DOIUrl":"10.1016/j.ssmmh.2025.100553","url":null,"abstract":"<div><h3>Background</h3><div>Despite dyadic interdependence of preparedness for death, associations of death preparedness (conjoint cognitive prognostic awareness and emotional acceptance) with psychological distress and quality of life (QOL) have been mainly examined cross-sectionally in patients or caregivers. This study longitudinally assessed associations of patient-caregiver concordance on death preparedness with dyads' psychological distress, QOL, and caregivers’ burden.</div></div><div><h3>Patients/methods</h3><div>Among 520 Taiwanese terminal cancer dyads, multivariate hierarchical linear models examined associations between death-preparedness concordance and anxiety, depression, QOL, and caregiving burden, separately for patients and caregivers across four concordant states (unprepared-concordant, cognitive-concordant, emotional-concordant, and sufficient-concordant) versus discordance, reported as β estimates with 95 % confidence intervals.</div></div><div><h3>Results</h3><div>Death-preparedness concordance was associated with outcomes, except unprepared concordance showed no association with patient outcomes, and emotional concordance was unrelated to caregiver outcomes. Relative to the discordant group, patients in the cognitive-concordant state had more anxiety (0.927 [0.364, 1.490]) and worse QOL (−3.933 [-6.661, −1.205]), whereas those in the emotional-concordant state had fewer symptoms of anxiety (−1.913 [-3.154, −0.672]) and depression (−1.617 [-3.128, −0.106]). The sufficient-concordant state was associated with fewer anxiety symptoms (−0.940 [-1.471, −0.409]) and better QOL (4.119 [1.252, 6.986]). Caregivers in unprepared- and cognitive-concordant states had more depressive symptoms and worse QOL, while those in the sufficient-concordant state reported fewer depressive symptoms (−1.960 [-3.348, −0.572]) and better QOL (3.922 [1.419, 6.425]). Cognitive-concordant caregivers also reported higher subjective burden (2.228 [0.962, 3.494]).</div></div><div><h3>Conclusions</h3><div>Sufficient concordance in death preparedness reduces patient anxiety and caregiver depression while improving dyads’ QOL, underscoring its role in enhancing end-of-life outcomes.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100553"},"PeriodicalIF":2.6,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-21DOI: 10.1016/j.ssmmh.2025.100551
Clariana Vitória Ramos de Oliveira , Silvana Freire , Juliet K. McCann , Michael Ochieng , Joshua Jeong
This study examined associations between perceived social support, maternal mental health, and parenting practices among mothers with young children under aged 2 years in rural Western Kenya. Data were collected as part of the baseline evaluation of a cluster randomized controlled trial evaluating a parenting intervention. Maternal perceived social support was reported using the Multidimensional Scale of Perceived Social Support, and community connectedness with two study-developed items. Maternal depressive symptoms were measured using the CES-D, parenting distress with Parenting Stress Index–Short Form, and caregiver stimulation practices with Family Care Indicators. Multilevel linear regression models examined associations between social support and maternal mental health and parenting outcomes. The analytic sample included 539 mothers, of whom 49.4 % were aged 25–34 years, 36.4 % were at risk of depression, and 19.9 % reported high parenting stress. Higher perceived support was associated with fewer depressive symptoms (β = −0.14, p < .001), lower parenting stress (β = −0.24, p < .001), and greater stimulation practices (β = 0.08, p = .04). Family support was more strongly associated with mental health outcomes, while friend support was associated with stimulation. Community connectedness was associated with lower parenting stress but not with depressive symptoms. Findings highlight the importance of family support for maternal well-being and peer support for fostering stimulation practices among mothers with young children.
本研究调查了肯尼亚西部农村地区2岁以下幼儿母亲的感知社会支持、母亲心理健康和育儿实践之间的关系。数据收集作为评估父母干预的集群随机对照试验的基线评估的一部分。使用感知社会支持的多维尺度和社区连通性与两个研究开发的项目来报告母亲感知社会支持。使用ce - d量表测量母亲抑郁症状，使用父母压力指数简表测量父母压力，使用家庭照顾指标测量照顾者刺激实践。多水平线性回归模型检验了社会支持与产妇心理健康和育儿结果之间的关系。分析样本包括539名母亲，其中49.4%的年龄在25-34岁之间，36.4%的人有抑郁风险，19.9%的人有很高的育儿压力。更高的感知支持与更少的抑郁症状（β = - 0.14, p < .001）、更低的养育压力（β = - 0.24, p < .001）和更多的刺激实践（β = 0.08, p = .04）相关。家庭支持与心理健康结果的关系更为密切，而朋友支持与刺激有关。社区联系与较低的养育压力有关，但与抑郁症状无关。调查结果强调了家庭支持对孕产妇福祉的重要性，以及同伴支持对在有幼儿的母亲中促进刺激做法的重要性。
{"title":"Social support and its associations with mental health and parenting among mothers with young children in Western Kenya","authors":"Clariana Vitória Ramos de Oliveira , Silvana Freire , Juliet K. McCann , Michael Ochieng , Joshua Jeong","doi":"10.1016/j.ssmmh.2025.100551","DOIUrl":"10.1016/j.ssmmh.2025.100551","url":null,"abstract":"<div><div>This study examined associations between perceived social support, maternal mental health, and parenting practices among mothers with young children under aged 2 years in rural Western Kenya. Data were collected as part of the baseline evaluation of a cluster randomized controlled trial evaluating a parenting intervention. Maternal perceived social support was reported using the Multidimensional Scale of Perceived Social Support, and community connectedness with two study-developed items. Maternal depressive symptoms were measured using the CES-D, parenting distress with Parenting Stress Index–Short Form, and caregiver stimulation practices with Family Care Indicators. Multilevel linear regression models examined associations between social support and maternal mental health and parenting outcomes. The analytic sample included 539 mothers, of whom 49.4 % were aged 25–34 years, 36.4 % were at risk of depression, and 19.9 % reported high parenting stress. Higher perceived support was associated with fewer depressive symptoms (β = −0.14, p < .001), lower parenting stress (β = −0.24, p < .001), and greater stimulation practices (β = 0.08, p = .04). Family support was more strongly associated with mental health outcomes, while friend support was associated with stimulation. Community connectedness was associated with lower parenting stress but not with depressive symptoms. Findings highlight the importance of family support for maternal well-being and peer support for fostering stimulation practices among mothers with young children.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100551"},"PeriodicalIF":2.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-17DOI: 10.1016/j.ssmmh.2025.100550
Ngozi V. Enelamah , Rochelle L. Frounfelker , Audrey Montgomery , Farhad Sharifi , Said Hasib Arwal , Caroline Dilts , Theresa S. Betancourt
Globally, unaccompanied minors face more significant risks for poorer mental health and other psychosocial issues while also grappling with mental health, language, and acculturation challenges. The United States admitted 1550 unaccompanied Afghan minors (UAMs) as humanitarian parolees among some 76,000 Afghans evacuated following the US withdrawal and Taliban takeover in 2021. Most UAMs had lived all their lives in Afghanistan's protracted conflict. Now resettled in the U.S., it is critical to understand their experiences to inform services, prevent common mental health problems, and strengthen pathways for their development. This study examined the recently arrived UAMs' needs and challenges in resettlement.
The study gathered data from free listing interviews and focus groups with UAMs and their caregivers (n = 29). Guided by a transactional ecological model, thematic content analysis was used to identify and categorize problem clusters and common themes outlined by UAMs and caregivers. UAMs were primarily concerned about being separated from their families and expressed sadness, longing, and grief. Other problems include language barriers and mental health symptoms that affect functioning across their ecological levels of development. Caregivers emphasized challenges related to adjusting to the American cultural context.
Findings support the pressing need to design and provide culturally relevant services to reduce mental health problems, strengthen family relationships, and engender positive future outcomes. The results have implications for the provision of equitable mental health services for resettled Afghan youth.
{"title":"“As you know, parents' love differs from others.” Understanding needs and strengths shaping mental health among unaccompanied Afghan minors in resettlement in the U.S.","authors":"Ngozi V. Enelamah , Rochelle L. Frounfelker , Audrey Montgomery , Farhad Sharifi , Said Hasib Arwal , Caroline Dilts , Theresa S. Betancourt","doi":"10.1016/j.ssmmh.2025.100550","DOIUrl":"10.1016/j.ssmmh.2025.100550","url":null,"abstract":"<div><div>Globally, unaccompanied minors face more significant risks for poorer mental health and other psychosocial issues while also grappling with mental health, language, and acculturation challenges. The United States admitted 1550 unaccompanied Afghan minors (UAMs) as humanitarian parolees among some 76,000 Afghans evacuated following the US withdrawal and Taliban takeover in 2021. Most UAMs had lived all their lives in Afghanistan's protracted conflict. Now resettled in the U.S., it is critical to understand their experiences to inform services, prevent common mental health problems, and strengthen pathways for their development. This study examined the recently arrived UAMs' needs and challenges in resettlement.</div><div>The study gathered data from free listing interviews and focus groups with UAMs and their caregivers (n = 29). Guided by a transactional ecological model, thematic content analysis was used to identify and categorize problem clusters and common themes outlined by UAMs and caregivers. UAMs were primarily concerned about being separated from their families and expressed sadness, longing, and grief. Other problems include language barriers and mental health symptoms that affect functioning across their ecological levels of development. Caregivers emphasized challenges related to adjusting to the American cultural context.</div><div>Findings support the pressing need to design and provide culturally relevant services to reduce mental health problems, strengthen family relationships, and engender positive future outcomes. The results have implications for the provision of equitable mental health services for resettled Afghan youth.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100550"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/j.ssmmh.2025.100549
C. Martin , A. Wittkowski , R. Agass , E. Camacho , A. Falana , R. Hale , M. Hann , A. Ifezue , H. Lemetyinen , S. Lewis , H. Myers , J. Nicholas , C. Stockton-Powdrell , C. Tower , K. Watson , P. Whelan , E. Eisner
Background
Around 17 % of mothers experience postnatal depression (PND) in the year after childbirth, with suicide the leading cause of direct maternal death between 6 weeks and 12 months postpartum. As approximately half of PND cases go undetected, digital screening tools have been developed to improve identification. However, implementing innovations into routine care is challenging, with contextual factors and staff views influencing uptake. This study explored healthcare professionals’ (HCPs) views on digital screening for PND, including feasibility, acceptability, and perceived barriers and facilitators to implementation.
Methods
HCPs (n = 30) involved in the care of pregnant/postpartum women and birthing people within the UK's National Health Service took part in semi-structured qualitative interviews. Data were analysed using Framework Analysis, with a combined inductive and deductive approach. Initial inductive themes were mapped, deductively, onto the Consolidated Framework for Implementation Research (CFIR) to aid interpretation and explanation of findings.
Results
Interview content aligned with all five CFIR domains, though most data mapped to the innovation characteristics (e.g., innovation evidence, relative advantage, complexity) and inner setting (e.g., IT infrastructure, culture, compatibility) domains. These reflected views on the digital screening system and the healthcare organization, respectively. Less content mapped to individual characteristics, outer setting, and implementation process domains. Facilitators were primarily linked to the innovation itself, while barriers typically related to organisational factors.
Conclusion
HCPs viewed digital screening as acceptable and aligned with broader digitalisation goals. While they recognised its potential benefits, concerns about feasibility and integration into routine care remained. Stakeholder consultation was seen as essential for successful implementation.
{"title":"Digital screening for postnatal depression: A qualitative study and framework analysis exploring the views of healthcare professionals","authors":"C. Martin , A. Wittkowski , R. Agass , E. Camacho , A. Falana , R. Hale , M. Hann , A. Ifezue , H. Lemetyinen , S. Lewis , H. Myers , J. Nicholas , C. Stockton-Powdrell , C. Tower , K. Watson , P. Whelan , E. Eisner","doi":"10.1016/j.ssmmh.2025.100549","DOIUrl":"10.1016/j.ssmmh.2025.100549","url":null,"abstract":"<div><h3>Background</h3><div>Around 17 % of mothers experience postnatal depression (PND) in the year after childbirth, with suicide the leading cause of direct maternal death between 6 weeks and 12 months postpartum. As approximately half of PND cases go undetected, digital screening tools have been developed to improve identification. However, implementing innovations into routine care is challenging, with contextual factors and staff views influencing uptake. This study explored healthcare professionals’ (HCPs) views on digital screening for PND, including feasibility, acceptability, and perceived barriers and facilitators to implementation.</div></div><div><h3>Methods</h3><div>HCPs (n = 30) involved in the care of pregnant/postpartum women and birthing people within the UK's National Health Service took part in semi-structured qualitative interviews. Data were analysed using Framework Analysis, with a combined inductive and deductive approach. Initial inductive themes were mapped, deductively, onto the <em>Consolidated Framework for Implementation Research</em> (CFIR) to aid interpretation and explanation of findings.</div></div><div><h3>Results</h3><div>Interview content aligned with all five CFIR domains, though most data mapped to the <em>innovation characteristics</em> (e.g., innovation evidence, relative advantage, complexity) and <em>inner setting</em> (e.g., IT infrastructure, culture, compatibility) domains. These reflected views on the digital screening system and the healthcare organization, respectively. Less content mapped to <em>individual characteristics</em>, <em>outer setting</em>, and <em>implementation process</em> domains. Facilitators were primarily linked to the innovation itself, while barriers typically related to organisational factors.</div></div><div><h3>Conclusion</h3><div>HCPs viewed digital screening as acceptable and aligned with broader digitalisation goals. While they recognised its potential benefits, concerns about feasibility and integration into routine care remained. Stakeholder consultation was seen as essential for successful implementation.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100549"},"PeriodicalIF":2.6,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/j.ssmmh.2025.100548
Scott Lamont , Chris McAteer , Leshia Patterson
Background
Peer Support Workers are increasingly recognised as integral components of person-centred care provision within mental health services globally, and their presence within early intervention services is expanding. The benefits that peer support workers provide are well established, but less is known about how to quickly and effectively integrate them within early intervention services to maximise their role.
Aim
This study explored barriers and enablers to effective implementation of peer support worker roles in early intervention services, through multi-stakeholder perceptions and insights involving service users, peer support workers, and clinicians.
Methods
A qualitative, multi-site study within an NHS Foundation Trust in the North-West of England was employed. Semi-structured interviews with 18 participants across the three stakeholder groups were conducted, with Normalisation Process Theory guiding the collection and interpretation of participant data to identify barriers and enablers. Data were analysed thematically using a six-phase, deductive approach.
Results
Four core themes and nine sub-themes emerged from collated participant data, providing context across Normalisation Process Theory constructs. The four core themes related to: Navigating Uncertainty and Discovering Value, Building Engagement through Trust and Relatability, Structural and Relational Conditions Shaping the Functions of PSWs, and Recognising Impact in the Absence of Formal Structures.
Conclusion
Effective integration in this context is underpinned by dynamic, relational factors. A theory of integration and logic model were developed to support policy and implementation efforts. These emphasise the need for comprehensive onboarding and evaluation mechanisms, and consideration of sustainability for these roles.
{"title":"Bridging the Gap: Towards a theory of peer-support worker integration within early intervention psychosis services","authors":"Scott Lamont , Chris McAteer , Leshia Patterson","doi":"10.1016/j.ssmmh.2025.100548","DOIUrl":"10.1016/j.ssmmh.2025.100548","url":null,"abstract":"<div><h3>Background</h3><div>Peer Support Workers are increasingly recognised as integral components of person-centred care provision within mental health services globally, and their presence within early intervention services is expanding. The benefits that peer support workers provide are well established, but less is known about how to quickly and effectively integrate them within early intervention services to maximise their role.</div></div><div><h3>Aim</h3><div>This study explored barriers and enablers to effective implementation of peer support worker roles in early intervention services, through multi-stakeholder perceptions and insights involving service users, peer support workers, and clinicians.</div></div><div><h3>Methods</h3><div>A qualitative, multi-site study within an NHS Foundation Trust in the North-West of England was employed. Semi-structured interviews with 18 participants across the three stakeholder groups were conducted, with Normalisation Process Theory guiding the collection and interpretation of participant data to identify barriers and enablers. Data were analysed thematically using a six-phase, deductive approach.</div></div><div><h3>Results</h3><div>Four core themes and nine sub-themes emerged from collated participant data, providing context across Normalisation Process Theory constructs. The four core themes related to: <em>Navigating Uncertainty and Discovering Value, Building Engagement through Trust and Relatability, Structural and Relational Conditions Shaping the Functions of PSWs,</em> and <em>Recognising Impact in the Absence of Formal Structures</em>.</div></div><div><h3>Conclusion</h3><div>Effective integration in this context is underpinned by dynamic, relational factors. A theory of integration and logic model were developed to support policy and implementation efforts. These emphasise the need for comprehensive onboarding and evaluation mechanisms, and consideration of sustainability for these roles.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100548"},"PeriodicalIF":2.6,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/j.ssmmh.2025.100547
Kaitlin Shartle , Jennifer E. Lansford , Marcos Vera-Hernández , Arnab Mukherji , Manoj Mohanan , Joanna Maselko
Activity of daily living (ADL) limitations, such as difficulty walking or dressing, are increasing as populations age and experience more chronic conditions. To understand the scope of ADLs and make interventions more effective, it is important to examine ADLs beyond the individual to other levels and contexts, such as the household. Thus, using household and individual level survey data in India, we assess how household ADLs relate to the mental health of others in the household. We find that around 40 % of households have at least one resident with an ADL limitation, with ADL limitations more likely in households that are in rural areas, have older residents, and are socioeconomically disadvantaged. Household ADL limitations are associated with increased symptoms of depression and anxiety with the relation varying by the number of household members with an ADL limitation. For adults, having any household member with an ADL limitation is associated with increased mental health symptomology, whereas for young adults, this association only appears for those with multiple household members with an ADL limitation. Further, we find that the relation between household ADL limitations and mental health is stronger for those living in rural areas compared to urban areas. That is, when comparing individuals with the same number of household members with ADL limitations, predicted mental health symptomology is higher for those living in rural areas than for those in urban areas. These findings suggest the need for household centered accommodations and supports that consider the social and environmental context.
{"title":"Beyond the individual: Household activity of daily living limitations, urban-rural residence, and mental health","authors":"Kaitlin Shartle , Jennifer E. Lansford , Marcos Vera-Hernández , Arnab Mukherji , Manoj Mohanan , Joanna Maselko","doi":"10.1016/j.ssmmh.2025.100547","DOIUrl":"10.1016/j.ssmmh.2025.100547","url":null,"abstract":"<div><div>Activity of daily living (ADL) limitations, such as difficulty walking or dressing, are increasing as populations age and experience more chronic conditions. To understand the scope of ADLs and make interventions more effective, it is important to examine ADLs beyond the individual to other levels and contexts, such as the household. Thus, using household and individual level survey data in India, we assess how household ADLs relate to the mental health of others in the household. We find that around 40 % of households have at least one resident with an ADL limitation, with ADL limitations more likely in households that are in rural areas, have older residents, and are socioeconomically disadvantaged. Household ADL limitations are associated with increased symptoms of depression and anxiety with the relation varying by the number of household members with an ADL limitation. For adults, having any household member with an ADL limitation is associated with increased mental health symptomology, whereas for young adults, this association only appears for those with multiple household members with an ADL limitation. Further, we find that the relation between household ADL limitations and mental health is stronger for those living in rural areas compared to urban areas. That is, when comparing individuals with the same number of household members with ADL limitations, predicted mental health symptomology is higher for those living in rural areas than for those in urban areas. These findings suggest the need for household centered accommodations and supports that consider the social and environmental context.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100547"},"PeriodicalIF":2.6,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-13DOI: 10.1016/j.ssmmh.2025.100546
Oda Woll Naug
This article explores the interconnection between municipal mental healthcare provision for patients with co-occurring disorders and the overreaching discourse of individualization in healthcare governance. The central research question is: In which way do the (orthodox) neoliberal discourse of individualization manifest within the subfield of mental healthcare, and how does individualization crystallize in service delivery for patients with co-occurring disorders in Norway? The study is based on interviews with ten municipal healthcare providers in rehabilitation, residential and follow-up services. The logics of self-responsibility and moral selection are identified as key logics in service provision and delivery. These logics overlap with the orthodox neoliberal discourse of individualization in welfare state governance, emphasizing patients' independence, empowerment and self-management. Individual-specific characteristics such as insight, motivation and substance use functions as selection criteria when patients seek help from municipal services. These logics reveal a paradox wherein patients are perceived as simultaneously capable and incapable of exercising rational control over their own action and yet are expected to take responsibility for their recovery. The article argues that the discourse of individualization, prominent in mental healthcare traditions like recovery and evidence-based practice, veils logics of self-responsibility and moral selection, placing more responsibility on patients to adapt to the healthcare system's framework. The symbolic power embedded in the ‘common sense’ discourse of individualization contributes to the (re)production of systemic marginalization, where structural barriers are obscured, and the patient's ability to adapt becomes essential in determining whether they are (mis)framed as “treatable,” “treatment-resistant,” or “too ill” to be helped.
{"title":"The logics of self-responsibility and moral selection: Neoliberal (mis)framing as symbolic violence in Norwegian municipal mental healthcare","authors":"Oda Woll Naug","doi":"10.1016/j.ssmmh.2025.100546","DOIUrl":"10.1016/j.ssmmh.2025.100546","url":null,"abstract":"<div><div>This article explores the interconnection between municipal mental healthcare provision for patients with co-occurring disorders and the overreaching discourse of individualization in healthcare governance. The central research question is: In which way do the (orthodox) neoliberal discourse of individualization manifest within the subfield of mental healthcare, and how does individualization crystallize in service delivery for patients with co-occurring disorders in Norway? The study is based on interviews with ten municipal healthcare providers in rehabilitation, residential and follow-up services. The logics of self-responsibility and moral selection are identified as key logics in service provision and delivery. These logics overlap with the orthodox neoliberal discourse of individualization in welfare state governance, emphasizing patients' independence, empowerment and self-management. Individual-specific characteristics such as insight, motivation and substance use functions as selection criteria when patients seek help from municipal services. These logics reveal a paradox wherein patients are perceived as simultaneously capable and incapable of exercising rational control over their own action and yet are expected to take responsibility for their recovery. The article argues that the discourse of individualization, prominent in mental healthcare traditions like recovery and evidence-based practice, veils logics of self-responsibility and moral selection, placing more responsibility on patients to adapt to the healthcare system's framework. The symbolic power embedded in the ‘common sense’ discourse of individualization contributes to the (re)production of systemic marginalization, where structural barriers are obscured, and the patient's ability to adapt becomes essential in determining whether they are (mis)framed as “treatable,” “treatment-resistant,” or “too ill” to be helped.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100546"},"PeriodicalIF":2.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-08DOI: 10.1016/j.ssmmh.2025.100545
Ida Salusky , Robin Remich , Lidia Monjaras-Gaytan , Cilka Mayumi Hijara , Richard McGee
Biomedical doctoral trainees experience high rates of mental health distress compared to the general population. Minoritized students are particularly vulnerable to psychological stress during training due to systemic factors including discrimination, bullying, financial constraints, high workloads and constant critical feedback. As such, the mental health of minoritized biomedical trainees is both a social justice and health equity issue. We examined longitudinal narratives of 33 Asian, Black and Latiné women in biomedical doctoral programs to understand how they constructed support systems to manage psychological distress induced by training environments and how institutional agents can effectively support student psychological wellness. By examining the experiences of graduate students over time, we found that students expend time and energy to create support systems using a variety of resources. Using Bronfenbrenner's Ecological Model, the findings show that constructing support can present challenges, particularly when norms and structures of biomedical training conflict with practices to foster good health. We present three themes: 1) students find authentic support through family, friends, and pre-PhD mentors; 2) students seek support from health professionals, though not all services were readily available or perceived as a good fit; and 3) fewer than half of participants experienced support for their mental health from PhD mentors (PIs of their lab).
{"title":"Support systems impacting the mental health of diverse women in biomedical science programs: An ecological approach","authors":"Ida Salusky , Robin Remich , Lidia Monjaras-Gaytan , Cilka Mayumi Hijara , Richard McGee","doi":"10.1016/j.ssmmh.2025.100545","DOIUrl":"10.1016/j.ssmmh.2025.100545","url":null,"abstract":"<div><div>Biomedical doctoral trainees experience high rates of mental health distress compared to the general population. Minoritized students are particularly vulnerable to psychological stress during training due to systemic factors including discrimination, bullying, financial constraints, high workloads and constant critical feedback. As such, the mental health of minoritized biomedical trainees is both a social justice and health equity issue. We examined longitudinal narratives of 33 Asian, Black and Latiné women in biomedical doctoral programs to understand how they constructed support systems to manage psychological distress induced by training environments and how institutional agents can effectively support student psychological wellness. By examining the experiences of graduate students over time, we found that students expend time and energy to create support systems using a variety of resources. Using Bronfenbrenner's Ecological Model, the findings show that constructing support can present challenges, particularly when norms and structures of biomedical training conflict with practices to foster good health. We present three themes: 1) students find authentic support through family, friends, and pre-PhD mentors; 2) students seek support from health professionals, though not all services were readily available or perceived as a good fit; and 3) fewer than half of participants experienced support for their mental health from PhD mentors (PIs of their lab).</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100545"},"PeriodicalIF":2.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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