Development and Validation of the Outcomes of WeLlbeing and Distress Scale for Adults With an Intellectual Disability (OWLS-ID), Formally Known as the PTOS-ID.

There are few valid and reliable psychological therapy outcome measures available for use with people with intellectual disabilities (ID). The current study involved the development of a new scale; the Psychological Therapies Outcome Scale - Intellectual Disabilities (PTOS-ID), and the examination of its validity and internal consistency. The PTOS-ID was administered to 175 people who have ID accessing specialist ID services. The construct validity of the scale was investigated through exploratory factor analysis, concurrent validity through comparison with the Brief Symptom Inventory and internal reliability through internal consistency analysis. Three factors emerged from the principal components analysis with high levels of internal consistency: (1) anger and mood (α=0.82); (2) positive well-being (α=0.81); and (3) anxiety (α=0.76). Factors (1) and (2) were combined to measure psychological distress (α=0.85), which correlated strongly with the Global Severity Index of the Brief Symptom Inventory (r=0.85). This preliminary study suggests that the PTOS-ID is a psychometrically robust measure of psychological distress and psychological well-being that can be used with people with ID. Further research is required to assess its reliability and ability to detect change.

There is little research on health-promoting workplace settings focused on people with an intellectual disability. There are a range of supported and open employment workplaces where people with an intellectual disability work, and this is an important setting that can influence health and wellbeing outcomes. The health promotion research that has been conducted with people with an intellectual disability has been programmatic in focus and lacks a broader settings and ecological perspective. This paper reports on analysis conducted across four organisations that employ people with an intellectual disability and included 47 in-depth interviews conducted with staff and supported employees. The aim was to examine the organisational characteristics, structures, and cultural elements that contribute to positive wellbeing. The key elements were offering a diversity of roles and opportunities, customised training and task matching, a flexible approach to work rosters, offering a range of workplace environments (e.g., busy versus calm environments), and providing holistic and tailored support. The results illustrate that providing positive wellbeing outcomes in the workplace for this cohort cannot be considered from a program perspective but as a whole of organisation design and culture. With the current movement towards more opportunity in open employment, it will be important that these features are replicated in all workplaces where people with an intellectual disability are employed. Further research and policy work is required for this ambition to be realised.

PurposeInsecure and unresolved attachments have been linked to poorer psychological health and interpersonal functioning for people with intellectual disabilities (IDs), but research in this area is limited, especially for adults. Studies using the Adult Attachment Projective (AAP) have been restricted to clinical samples, where insecure and unresolved attachments are typically more prevalent. The purpose of this study is to compare clinical and non-clinical groups of adults with IDs on the AAP, plus measures of psychological health and interpersonal functioning, to investigate whether group differences found in the typically developing population are also present for adults with IDs.Design/methodology/approachA cross-sectional, between-group design was used. Adults with IDs (clinical group n = 11 and non-clinical group n = 13) completed measures of attachment, psychological distress/positive well-being and interpersonal functioning. Attachment classifications were compared in the clinical versus non-clinical groups. Measures of psychological distress, positive well-being and interpersonal functioning were compared between those with insecure-organised versus unresolved classifications.FindingsNo participants were classified as secure, and there were high rates of unresolved attachment. There were no differences between clinical and non-clinical groups with regards to the distribution of insecure-organised (i.e. dismissing or preoccupied) versus unresolved classifications. There were no differences between groups with regards to psychological distress, positive well-being or interpersonal functioning. The authors consider limitations in the method of group differentiation and suggest further research to better understand the development of internal working models of attachment in this population.Originality/valueTo the best of the authors’ knowledge, this study is one of only three to examine attachment state of mind in adults with IDs using the AAP and the first to examine differences between clinical and non-clinical groups.

BackgroundDuring COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level.ObjectiveThis study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress).MethodsA 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively.ResultsThe intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P<.001; Wilks Λ=.71; partial η2=.29) showing small to moderate effect sizes on individual outcomes. The largest effect sizes were observed for life satisfaction and overall well-being (η2=.22 and η2=.2, respectively). Larger effect sizes were noted for those with problematic mental health scores at baseline. A total of 92% (82/89) of participants demonstrated reliable change in at least one mental health outcome. Differential response patterns using RCI revealed that more than one-half of the participants showed improvement in both mental well-being and psychological distress, over one-quarter in outcomes of well-being only, and almost one-fifth in distress only.ConclusionsThe results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness.

Interaction with individuals with severe motor and intellectual disabilities and nurses' positive mental well-being.

BackgroundInformal carers of people with BPD experience high levels of burden and psychological distress relative to other populations. There is a scarcity of research evidencing the influence of modifiable factors on carer outcomes to inform interventions. This study aimed to investigate the relationship between social support, coping strategies and psychological distress and positive mental well-being in this carer population.MethodsIn this cross-sectional study, 1207 carers completed the McLean Screening Instrument for BPD-Carer Version, the Brief COPE, the Multidimensional Scale of Perceived Social Support, the Kessler Psychological Distress scale, the WHO-5 Well-being Index, and the Coronavirus Anxiety Scale. Data for 863 participants who met the inclusion criteria were analysed.ResultsCarers reported low positive mental well-being and high psychological distress. Perceived social support and several coping strategies were significant unique predictors of psychological distress and positive mental well-being. Perceived social support and positive reframing were the strongest predictors of higher positive mental well-being and lower psychological distress. Self-blame, behavioural disengagement and substance use were the strongest predictors of adverse outcomes.ConclusionsThe findings evidence modifiable factors that may be used to improve informal carer outcomes and indicate that carer interventions may be improved by focusing on reducing the use of self-blame, behavioural disengagement and substance use, and development of quality social support and skills to positively reframe caregiving situations.

Prisoners with intellectual disability who have a coexisting mental health issue often have unmet health needs and are more likely to reoffend than those with intellectual disability alone. The aims of this study were to estimate the prevalence of co-occurring mental disorder among prisoners with intellectual disability and to explore the association between intellectual disability and mental disorder. Cross-sectional study of adult prisoners within 6 weeks of release from custody in seven prisons in Queensland, Australia between August 2008 and July 2010. Intellectual disability was assessed using a practical composite screening tool. Prisoners who scored <85 on the Hayes Ability Screening Index and reported either having attended a special school or having been diagnosed with intellectual disability were identified as having an intellectual disability. Mental health was assessed using self-reported psychiatric diagnoses, the Kessler Psychological Distress Scale (K-10), and the Mental Component Summary score of the Short-Form-36 health survey version 2. The association between intellectual disability and mental health was assessed using univariate and multivariate logistic regression. Overall, 1279 prisoners completed the HASI: 316 (24%) scored below the recommended cut off for further diagnostic assessment of intellectual disability, 181 (14%) reported attending a special school, and 56 (4%) reported that they had been diagnosed with an intellectual disability. On our composite measure, 115 (9%) participants were identified as having an intellectual disability. Among prisoners with intellectual disability, the estimated lifetime and current prevalence of co-occurring mental disorders was 52.5% (95% CI 43.3-61.5) and 37.2% (95% CI 28.8-46.5), respectively. Of those with intellectual disability, 13.5% (95% CI 8.3-21.1) reported very high psychological distress, as measured by the K10. Prisoners with intellectual disability were significantly more likely than their non-disabled peers to report a current diagnosis of depression [adjusted odds ratio (AOR) 1.8, 95% CI 1.1-3.2] or substance dependence (AOR 3.7, 95% CI 1.6-8.4], after adjusting for potentially confounding variables. Prisoners with intellectual disability were also significantly more likely than their non-disabled peers to use antipsychotic medication (AOR 1.7, 95% CI 1.0-2.8). Prisoners with an intellectual disability were more likely than their non-disabled peers to have elevated rates of psychiatric comorbidity and unmet treatment needs. There is a need for enhanced collaboration between specialist intellectual disability psychiatric services and mainstream prison mental health services, to ensure coordinated service delivery for this dually disadvantaged group.

An intellectual disability (ID) is characterized by a deficit in the functional, cognitive, and adaptive skills required for independent living. Due to the low cognitive capabilities of individuals with IDs, they have become victims of marginalization, exclusion, and denial of their fundamental rights to basic necessities in societies around the world. While efforts are being made to improve service provision to and acceptance of individuals with disabilities, the extent of communal acceptance and recognition of these individuals as equal members of society remains underexplored in sub-Saharan African countries such as Cameroon and Ghana. As attitudes toward individuals with IDs are pivotal in shaping national policies, this cross-national study examined communal attitudes toward persons with IDs in Cameroon and Ghana. The Community Living Attitude Scale for Intellectual Disabilities (CLAS-ID) was used to collect data from a total of 741 university students in the two countries. The validity of the scale was assessed using confirmatory factor analysis and principal component analysis. The association between the background variables and attitudes was examined using t-tests, analysis of variance, linear regression, and two-way factor analysis. The results showed the validity of the CLAS-ID as a valid tool for measuring communal attitudes toward individuals with IDs in sub-Saharan Africa. The participants appeared ambivalent about attitude towards individuals with ID and other findings showed no association between attitudes and variables such as gender, relation, and contact with individuals with IDs. We discuss the need for innovative approaches aimed at changing attitudes toward individuals with IDs in sub-Saharan Africa as well as other study implications.

BackgroundUnderstanding the outcomes associated with both receiving and providing support to people with intellectual disability in specific settings can facilitate the alignment of health providers, community care providers, architects, and urban planners to strengthen levels of autonomy and community participation of people with intellectual disability living in the community. This study explores the impact of providing support (available 24 hours a day) for people with intellectual disability in a high-density apartment. It seeks the perspectives of people with intellectual disability who have moved into an apartment from a group home (where 4-6 people with disability live), their families, and support staff. It will enable comparison between two models of supported accommodation, group homes and individualized apartments, in a community setting.ObjectiveThe aims of this study are to explore the impact of an individualized apartment model of supported accommodation in a high-density setting on the well-being, autonomy, and participation of people with intellectual disability living and receiving support; the experience of providing care or support; and how this setting impacts the logistics of how quality support is provided.MethodsQualitative research methods were employed as the primary means of collecting and analyzing data. There are two main sources of data in this study: (1) semistructured interviews with participants in up to 3 waves (pre, post 1, and post 2) and (2) pre- and postoccupancy evaluation data on the design, layout, and location details of the built environments. Coded interview data will be paired with pre- and postoccupancy evaluations of the two accommodation settings.ResultsAs of May 2020, we have recruited 55 participants. There have been 96 interviews conducted in 2 waves with people who have moved into supported accommodation, families, and staff. Collected data are currently being analyzed. We expect the results of the trial to be published in a peer-reviewed journal in late 2020.ConclusionsThis paper sets out a study of an alternative housing and support model for people with intellectual disability. It will capture personal experiences of people with intellectual disability receiving support in an apartment compared to their experiences in a group home. It will also capture the experiences of support staff working in the new setting and reveal how this differs from a group home setting. The inclusion of pre (group home) and post (apartment integrated into a community setting) measures addresses evaluative and comparative questions around the nature and impacts of the small-scale apartment and support model for both those who live and receive support, and those who support them.International Registered Report Identifier (IRRID)DERR1-10.2196/18248

Previous research on medical student wellbeing has examined single wellness-related behaviours in isolation and relied on cross-sectional or pre-post surveys. The objective of this study was to use daily, app-based surveys to examine which wellness behaviours have the strongest associations with positive wellbeing in a medical student sample. A total of 213 medical students willing to participate were enrolled in this study during summer 2021. Participants completed nightly surveys on a novel smartphone app, which assessed eight wellness-related indicators (e.g., social interaction, sleep, exercise, nutrition) and four wellbeing outcomes (mood, focus, stress, overall wellbeing). Both same-day and next-day associations between indicators and outcomes were assessed. Of the 213 participants enrolled, 116 completed more than 50% of nightly surveys, providing 7043 observations over 3 months. All wellbeing outcomes varied significantly within a given week, with peak stress and lowest mood and wellbeing levels at the midweek mark. In cross-sectional/same-day analyses, quality of social interactions, sleep quality and nutrition had the strongest associations with same-day outcomes. The cumulative impact of engaging in these wellness indicators was equal to a one standard deviation higher score on same-day wellbeing and mood outcomes. In longitudinal/next-day analyses, quality of social interactions and sleep quality had the strongest associations with outcomes, but the associations were generally modest compared to same-day results. A specific set of daily wellness behaviours may have substantial associations with mood, wellbeing and other positive outcomes, but the carryover of these behaviours to the next day is limited. Medical schools should test interventions that target multiple wellness activities and find ways to prompt these behaviours daily.

Background: This is the third article from a project on the wellbeing of staff, students, and parents at a Welsh-medium Secondary School. It focuses on the wellbeing of working mothers before COVID-19 lockdown, immediately after lockdown, and perceptions of the longer-term impact of the pandemic. The research used the wellbeing process model, which examines predictors of positive and negative wellbeing outcomes. Aims: The study had three aims. First, to examine whether the wellbeing process model can be applied to working mothers. Secondly, to investigate the addition of new variables to the model. Finally, to investigate the impact of the COVID-19 lockdown and identify predictors of post-lockdown wellbeing. Methodology: The research was carried out with the informed consent of the volunteers (N=202; mean age = 42.7 years, standard deviation (sd) = 8.5) and the approval of the School of Psychology, Cardiff University, ethics committee. An online survey was conducted, and regressions were carried out to investigate associations between the predictor variables and the wellbeing outcomes. Predictors of post-lockdown wellbeing were also investigated. Results: The pre-COVID results generally agreed with the predictions of the wellbeing model. Positive wellbeing was associated with job resources, social support, psychological capital and healthy lifestyle. It was negatively associated with negative coping and daytime sleepiness. Negative wellbeing was associated with job demands, negative coping, daytime sleepiness and finding stressful situations threatening. It was negatively associated with social support, a healthy lifestyle and stable personality. Positive wellbeing after the lockdown was associated with job resources and stable personality. It was negatively associated with social isolation and negative wellbeing. Social isolation was associated with the negative effect of the pandemic on longer-term wellbeing, and a healthy lifestyle was negatively associated with this variable. Conclusion: The results confirmed that the wellbeing process model applies to Welsh working mothers. Lockdown during COVID-19 affected wellbeing, with the stress of isolation being the most significant influence.

BackgroundAn intellectual disability (ID) is characterized by a deficit in the functional, cognitive, and adaptive skills required for independent living. Due to the low cognitive capabilities of individuals with IDs, they have become victims of marginalization, exclusion, and denial of their fundamental rights to basic necessities in societies around the world. While efforts are being made to improve service provision to and acceptance of individuals with disabilities, the extent of communal acceptance and recognition of these individuals as equal members of society remains underexplored in sub-Saharan African countries such as Cameroon and Ghana.ObjectiveAs attitudes toward individuals with IDs are pivotal in shaping national policies, this cross-national study examined communal attitudes toward persons with IDs in Cameroon and Ghana.MethodThe Community Living Attitude Scale for Intellectual Disabilities (CLAS-ID) was used to collect data from a total of 741 university students in the two countries. The validity of the scale was assessed using confirmatory factor analysis and principal component analysis. The association between the background variables and attitudes was examined using t-tests, analysis of variance, linear regression, and two-way factor analysis.ResultsThe results showed the validity of the CLAS-ID as a valid tool for measuring communal attitudes toward individuals with IDs in sub-Saharan Africa. The participants appeared ambivalent about attitude towards individuals with ID and other findings showed no association between attitudes and variables such as gender, relation, and contact with individuals with IDs.ConclusionWe discuss the need for innovative approaches aimed at changing attitudes toward individuals with IDs in sub-Saharan Africa as well as other study implications.

An Overview of Intellectual Disability: Definition, Diagnosis, Classification, and Systems of Supports (12th ed.).

BackgroundThe number of people with disabilities in Brazil and worldwide has grown substantially in recent decades. Cross-cultural quality of life instruments can be helpful in the development of interventions designed to meet the needs of this population and contribute to rational allocation of resources. This study sought to provide evidence of validity and reliability the Brazilian Portuguese version of WHOQOL-Dis-D (a cross-cultural, multicentre instrument developed by the WHOQOL-Group for the assessment of quality of life in persons with physical disability – PD) and WHOQOL-Dis-ID (for persons with intellectual disability – ID).MethodsClassical psychometric methods were used to conduct independent analyses of the PD and ID samples. Criterion groups were established for analysis of construct validity. Concurrent validity was assessed in relation to SWLS and BDI-II scores; discriminant validity, in relation to WHODAS-II. Cronbach alpha was used to test the instrument scales and subscales for reliability. The ID subgroup was retested, and test-retest reliability assessed by means of intraclass correlation coefficients and paired Student’s t-test.ResultsA total of 162 (98 females) people with PD and 156 (55 females) people with ID participated in the study. Cronbach alpha was satisfactory across practically all domains and factors in the PD subsample. In IDs, most factors or domains had coefficients higher than 0.70, but four subscales exhibited less satisfactory performance. Evidence of construct and concurrent validity and reliability were obtained.ConclusionsThe analyses presented herein provide satisfactory evidence of the validity and reliability of the instrument and corroborated the factor structure revealed during cross-cultural research. Further studies with larger sample sizes are required to obtain additional evidence of validity and reliability.

Mental health self-management (MHS) strategies may help workers with mental health concerns preserve and enhance their well-being. However, little research has explored how these strategies may help mitigate the effects of negative psychosocial work factors (PWFs) on well-being outcomes. This cross-sectional study investigated (1) the relationship between PWFs and well-being, (2) the association between MHS at work and well-being, and (3) the moderating role of self-management in preventing negative PWFs' deleterious effects. A sample of 896 Francophone workers in Canada completed a questionnaire that included self-reported measures related to workplace, self-management, and well-being. Structural equation modeling (conducted via the MPlus software, version 8.6) revealed that psychological demands were negatively related to positive well-being outcomes and positively associated with adverse well-being outcomes. Competency-related autonomy was positively associated with flourishing, and recognition was positively associated with flourishing and positive well-being at work, as well as being negatively associated with burnout and depression. Surprisingly, supervisor support was negatively related to positive well-being and positively related to burnout and depression. MHS was positively associated with positive well-being at work, flourishing, and work performance, but had no relationship with negative mental health. MHS significantly moderated the relationship between each PWF and well-being at work in both beneficial and adverse ways, depending on the specific well-being indicator being considered. From a workplace well-being perspective, this suggests that although self-management may help workers preserve and enhance their positive well-being, organizations must also directly target PWFs to prevent negative well-being outcomes.