Current Mental Illness Research Articles

Public awareness of Mental Health First Aid and perception of community pharmacists as Mental Health First Aid providers

ObjectivesThe objectives of this study were to (1) identify the number of participants who screened positive for major depressive disorder, (2) assess the number of participants who have discussed or would like to discuss mental illness with a trained professional, (3) determine public awareness about Mental Health First Aid (MHFA), and (4) determine public perception regarding community pharmacists trained in MHFA. MethodsA cross-sectional survey was administered at community pharmacies to participants aged 18 years and older who were able to speak and read in English. The 18-question survey was used to screen for major depressive disorder using the Patient Health Questionnaire-2 (PHQ-2) and to collect demographic information, mental health diagnoses, beliefs regarding current mental illness and treatment, desire and history of talking with a trained professional about mental illness, and MHFA awareness. In addition, data on comfortability talking to a pharmacist about mental illness was collected. Data were analyzed with an a priori α of 0.05. ResultsA total of 358 surveys were collected. Seven participants (2%) screened positive for depression using PHQ-2. One hundred eight participants (30.4%) reported a previous desire to speak to someone about mental illness; of these, only 41 (38.7%) and 63 patients (59.4%) reported speaking to a physician or therapist, respectively. Only 53 participants (15.4%) reported awareness of MHFA. Participants reported a higher level of comfortability (P < 0.01) speaking about mental illness with an MHFA-trained pharmacist. Similarly, participants more strongly agreed (P < 0.01) that pharmacists are qualified to discuss mental illness if trained in MHFA. Most participants believed pharmacists should be trained in MHFA (n = 260, 68.2%). ConclusionParticipants indicated comfortability discussing mental illness with community pharmacists trained in MHFA, revealing an opportunity for pharmacists to expand access to mental health services by being trained in MHFA and counseling about mental illness.

Negative Life Events and Suicide in the National Violent Death Reporting System

Objective Negative life events may be a major precipitating factor for suicide and may differ across sociodemographic groups. We used data from the National Violent Death Reporting System (NVDRS) to explore whether age, gender, current mental illness, and disclosure around suicide predicted adult decedents’ precipitants for suicide. Method: An NVDRS data set was used that included 58,247 adults who died by suicide between 2005 and 2010. Multivariate logistic regression was used to explore the relationship between sociodemographic characteristics and precipitating factors while controlling for the impact of other factors. Results: Age group (18–34, 35–64, or ≥ 65), sex, current mental illness, and disclosure around suicide significantly predicted various precipitants. Males were more likely than females to have most precipitating factors, particularly a criminal legal problem (odds ratio [OR]: 2.76), job problem (OR: 1.97), or financial problem (OR: 1.42). While younger decedents had more crises and intimate partner problems, middle-aged decedents had more loss of housing (OR: 1.87) and financial (OR: 1.81) and job-related (OR: 1.35) precipitants than the younger group. The odds of a physical health issue increased successively with each age group. Identified mental illness was associated most strongly with a job (OR: 1.43) or physical health problem (OR: 1.35). Individuals who disclosed suicidal ideation had a higher incidence of all precipitants. Conclusions: The precipitants to suicide appear to vary according to individuals’ demographic factors, current mental illness, and disclosure of intent. Our understanding of suicide may be enhanced by exploring the causal pathway behind these relationships.

An updated picture of the mental health needs of male and female prisoners in the UK: prevalence, comorbidity, and gender differences

PurposeEpidemiological data on the mental health needs of prisoners are essential for the organisation, planning, and delivery of services for this population as well as for informing policy and practice. Recent reports by the National Audit Office and NICE call for new research to provide an updated picture of the mental health needs of men and women in prison in the UK. This study aimed to measure the prevalence and comorbidity of mental health needs across a representative sample of both men and women across 13 prisons in one UK region.MethodParticipants completed a standardised battery of psychometric assessments which screened for a range of mental health difficulties including: mental disorders, personality disorder, and substance misuse.Results469 participants were included in the final sample (338 males, 131 females). A high number of participants reported having had previous contact with mental health services and/or a pre-existing diagnosis of a mental disorder. High rates of current mental disorder were detected across the range of disorders screened for. Levels of comorbidity were also high, with nearly half of participants screening positive for two or more types of mental disorder. Gender differences were noted in terms of previous contact with mental health services, having a pre-existing diagnosis, prevalence of current mental disorder, and levels of comorbidity; with women reporting higher rates than men.ConclusionsRates of pre-existing and current mental illness continue to be high amongst prisoners. Women report significantly higher levels of mental health need compared to men.

Discharge Against Medical Advice: A Tertiary Referral Centre Experience

Background: Discharge against medical advice (DAMA) is an infrequent event within hospital. It has been shown this group maybe more likely to have higher rates of readmission and post discharge mortality. Aims: To describe the clinical characteristics, comorbidities, organisational factors, and health outcomes of consecutive patients who DAMA in a large tertiary hospital. Methods: DAMA patients were identified by ICD codes during the period 2012–2017. Inpatient characteristics were sourced from the medical records. Length of hospital stay, 30-day readmission, and mortality rates were included and sourced from the Cardiac and Stroke outcomes. Results: A total of 69 patients were classified as DAMA during the study. The median age was 56 (IQR 47–66). Males were more likely to DAMA (75%). DAMA patients predominantly presented with ACS (64%), CHF (17%), and arrhythmia (13%). The cardiac co-morbidities of this group included prior PCI (28%), ischaemic heart disease (43%), diabetes (52%), heart failure (23%), and renal failure (23%). Indigenous patients accounted for 17% of this group. Additional patient characteristics showed that DAMA patients had a high rate of unemployment (51%), and 38% had a current mental illness. Of interest in a large geographical area, the median distance from home to hospital was 20km (IQR 10–47). This patient group showed a high 30-day readmission rate (45%), but low 30 day mortality rate. Conclusion: The incidence of DAMA is low. DAMA patients have identifiable comorbidities and complex social issues. DAMA does confer a high readmission rate. DAMA patients were more likely to be male and Indigenous.

Evaluating the Effectiveness of Clinical Pharmacy Consultations on Nutrition, Physical Activity, and Sleep in Improving Patient-Reported Psychiatric Outcomes for Individuals with Mental Illnesses.

One fifth of U.S. adults have a current mental illness. Nutrition, physical activity, and sleep are critical to physical health; any related deficiencies may worsen existing mental health conditions. Little is known about the impact of clinical pharmacist assessment and consultation in improving physical and mental health outcomes. The study objective was to determine whether patients’ mental health status improved following clinical pharmacist consultation. This pilot study involved clinical pharmacist-delivered services at an integrated medical behavioral health clinic in June 2018. Inclusion criteria required adults aged 18 years older, an established mental health diagnosis, and taking ≥2 prescribed psychotropic medications. One pharmacist conducted telephonic, medical, and psychiatric health risk assessment and counseling to improve nutrition, physical activity, and sleep status, both initially and at two-week follow-up. The Duke Health Profile (Duke) physical, anxiety, depression, and anxiety-depression scores measured patients’ pre/post changes. Participants (n = 20) experienced higher Duke physical scores (p = 0.007) and significantly lower anxiety (p = 0.025), depression (p = 0.001) and anxiety-depression scores (p = 0.005) at follow-up. This pilot study provides preliminary evidence for pharmacist-led, targeted, telephonic counseling in improving short-term physical and mental Duke health scores. Further research evaluating the impact of clinical pharmacists’ role in improving physical and behavioral health outcomes is warranted.

The CORE-10 in screening for current mental health problems and severe mental illness in prisoners.

Few mental health screening tools are validated for prisoners. Existing tools do not guide referral between primary and secondary care pathways. This study aimed to assess performance of the CORE-10 in screening any current mental health problem and current severe mental illness (SMI) in prisoners. CORE-10 ratings were compared with mini international neuropsychiatric interview (MINI) version 6.0 ratings and current practice outcomes for 150 male prisoners. Receiver operating curve (ROC) analyses were used to estimate the likelihood with which CORE-10 ratings matched MINI ratings, yielding "area under the curve" statistics. ROC analyses suggested a strong relationship between CORE-10 screen scores and the more detailed assessment both in identifying any problem (AUC 0.85) and severe mental illness (AUC 0.76). Sensitivity was 0.88 and 0.83, and specificity was 0.64 and 0.61, respectively. Retest reliability was moderate (ICC=0.83). The CORE-10 identified many cases of "any problem" and of severe illness also identified by the MINI who had not been referred to clinical services in routine practice. This study provides evidence for the potential of the CORE-10 for improving appropriate referrals for prisoners to mental health services.

Prediction of Mental Illness Using Indian Astrology: Cross-Sectional Findings from a Prospective Study

Studies involving astrology and psychiatry have mostly found confl icting results, with astrology being criticized as unscientifi c and also lacking an objective assessment method for being scientifi cally tested. We tested the predictive ability of astrology using the Indian system in identifying mental illness on 150 subjects (75 having mental illness and 75 without).Four astrologers blind to the subjects interpreted the computer-generated birth chart data derived from subject’s gender, and date, time, and place of birth. Predictions were matched with the clinical details at fi rst assessment.Kappa coeffi cients suggested a moderate agreement in the astrological prediction of lifetime mental illness (k = 0.560, p = .001) and a substantial agreement in predicting current state of mental illness (k = 0.626, p = .001),but with good inter- strologer agreement only for lifetime mental illness.Viewed as a diagnostic test, astrology showed a good sensitivity and specifi city for identifying mental illness of more than 75% for lifetime mental illness and more than 80% for the current mental illness. However, the study showed a poor match in predicting the symptom cluster and time of onset of symptoms. Overall, the evidence seemed to point toward Indian astrology (Vārāhamihira system) as practiced in the study modestly predicting the presence of mental illness. Caveats included diff erences in diagnostic concepts in the allopathic and astrological systems and the lack of a predefi ned level of astrological analysis which resulted in a poor match for symptom cluster and timing of illness. The fi ndings in this study hence are at best tentative and need more extensive enquiry.

Evaluation of perceptions and knowledge of mental illness in the United States through crowdsourcing

Introduction:Crowdsourcing is a method of data collection with possible benefits in assessing perceptions of mental illness in a large US population.Methods:The objective was to describe perceptions and trends of stigma surrounding mental illness in the United States using crowdsourcing. An online survey was conducted evaluating adults in the United States recruited via the online resource Amazon Mechanical Turk. Questions evaluated demographics and perceptions of mental illness. Survey data were adjusted for demographic variables and compared via logistic regression.Results:Respondents (n = 1422) were predominately 18 to 30 years of age (n = 743; 52.3%) and white (n = 1101; 77.4%). Over half reported an individual close to them had mental illness (n = 932; 65.5%), and more than one quarter (n = 397; 27.9%) reported having a current or previous mental illness. Non-whites were less likely to agree that: medications are effective (odds ratio [OR] 0.63); they would be comfortable around a coworker with mental illness (OR 0.66); and mental illness is inheritable (OR 0.74). They are also more likely to agree that mental illness is preventable (OR 1.49). Individuals reporting mental illness were more likely to agree that medications (OR 1.34; 95% confidence interval 1.03 to 1.74) and talk therapy (OR 1.46; 95% confidence interval 1.12 to 1.90) are effective. Those reporting some or no college were more likely to agree that the United States has good access to mental health treatment.Discussion:Crowdsourcing may be an effective way to obtain information regarding demographics, stigma, and mental illness. Personal experiences with mental illness, ethnicity, and educational level appear to continue to impact perceptions of mental illness.

Latent trajectory classes of postpartum depressive symptoms: A regional population-based longitudinal study

PurposeThis study aimed to (a) assess trajectories of women's depressive symptoms during the first year postpartum to (b) identify potential unobserved classes of women as defined by their trajectories, (c) identify antepartum and early postpartum risk factors associated with trajectory classes, and (d) examine the association between trajectory classes and counselling during the postpartum period. MethodsData on depressive symptoms, using the Edinburgh Postnatal Depression Scale (EPDS), were collected from 1374 women across nine Norwegian well-baby clinics at 1.5, 4, 6, and 12 months postpartum. Well-baby clinics offer universal, free services to all families living in the municipality. Thus, there were no specific exclusion criteria for this study. All clinics had implemented the Edinburgh–method which combines screening for PPD, using the EPDS, with supportive counselling. ResultsAnalyses showed that depressive symptoms decreased initially, followed by a flattening in symptoms at 6 months. Mixture analyses, however, identified two classes of women with distinct trajectories; (1) a low-risk (n = 1249, 91%) and (2) a high-risk group (n = 119, 9%). Complications after birth, elevated prenatal depressive symptoms, previous or current mental illness, and gestational week, predicted trajectory class membership. Women in the high-risk group were more likely to receive counselling than low-risk women. LimitationsWomen had higher educational level than the general population and one of the municipalities did not have a 12-months routine consultation. ConclusionFindings suggest heterogeneity among women in their depressive symptoms during the first year postpartum with a distinct set of risk factors associated with high-risk women. This has implications for the prevention and follow-up of women during pregnancy and the first year after childbirth.

Male sexual assault: Physical injury and vulnerability in 103 presentations

ObjectivesTo i) describe the demographic and assault characteristics of males alleging recent sexual assault, ii) determine the severity and frequency of general body injury and the frequency of anal and genital injury, iii) identify vulnerability factors and assault characteristics associated with injury. DesignCross-sectional study. SettingSexual Assault Resource Centre (SARC), Western Australia. Participants: Total of 103 post-pubertal males attending SARC from Jan-2009 to Dec-2016. MethodsMen underwent a standardised medical examination and data collection by forensically trained doctors following consent for general body and/or ano-genital examination. Men were considered vulnerable if at least one of the following factors was present: current mental illness; intellectual or physical disability; alcohol intoxication; previous sexual victimization; living in prison or homeless (no fixed address), aged < 18 years. Statistical analysis was performed by Fisher exact test. An algorithm was used to classify general body injuries as mild, moderate or severe. ResultsAt least one vulnerability factor was present in 88.3% of the 103 men. More than one factor was present in 54.4%. General body injury was observed in 58.0% (40/69) of men consenting to general body examination; 46.4%, 10.1% and 1.4% were classified as having respectively, mild, moderate and severe injuries. Three assault characteristics were associated with general body injury: the use of blunt force (p = 0.002), multiple assailants (p = 0.049) and deprivation of liberty (p = 0.040). Genital injury and anal injury was observed in, respectively, 6.5% (5/77) and 14.3% (11/77) of men consenting to ano-genital examination. Of the 49 men examined following completed penetrative anal assault, 18.4% (9/49) had anal injuries. In these 49 men, those assaulted by strangers were more likely to have an anal injury compared to non-stranger assaults (p = 0.019). No demographic, clinical or vulnerability characteristics of the sexually assaulted men were associated with general body, genital and/or anal injury. ConclusionAlthough general body injuries were more frequent than genital and anal injuries, most of the body injuries were mild in severity. While the majority of men in our study presented with one or more vulnerabilities only assault characteristics (not vulnerabilities) were associated with injury.

Barriers to identifying eating disorders in pregnancy and in the postnatal period: a qualitative approach

BackgroundEating Disorders (ED) are mental health disorders that typically effect women of childbearing age and are associated with adverse maternal and infant outcomes. UK healthcare guidance recommends routine enquiry for current and past mental illness in antenatal and postnatal care for all women, and that pregnant women with a known ED are offered enhanced monitoring and support. Midwives and health visitors are ideally placed to identify and support women with ED as they are often the primary point of contact during the antenatal and postnatal periods. However, research on the barriers to identifying ED in the perinatal period is limited. This study aimed to understand the barriers to disclosure and identification of ED in pregnancy and postnatally as perceived by women with past or current ED, and midwives and health visitors working in the UK National Health Service.MethodsTwo studies were undertaken: mixed-measures survey of pregnant and postnatal women with current or past ED; focus groups with student and qualified midwives and health visitors.ResultsFive themes emerged on the barriers to disclosure in pregnancy as perceived by women: stigma, lack of opportunity, preference for self-management, current ED symptomatology and illness awareness. Four themes were identified on the barriers to identification of ED in pregnancy and in the postnatal period as perceived by health professionals: system constraints, recognition of role, personal attitudes, and stigma and taboo.ConclusionsSeveral barriers to the identification of ED during and after pregnancy were described, the main factors were stigma and poor professional training. Perinatal mental health is becoming increasingly prioritised within national policy initiatives; however, ED continue to be neglected and increased awareness is needed. Similarly, clinical guidance aimed at responding to the rising prevalence of obesity focus on changing nutrition but not on assessing for the presence of ED behaviours that might be affecting nutrition. Improving education and training for health professionals may contribute to reducing stigma and increase confidence in identifying ED. The barriers identified in this research need to be addressed if recognition and response to women with ED during the perinatal period is to improve.

Understanding child protection decisions involving parents with mental illness and substance abuse

Among children investigated for maltreatment, those with parents experiencing mental illness or substance abuse are more likely to be placed out-of-home; however, little is known about why these children are at greater risk. Using a sample of 2488 Structured Decision Making® assessments administered in San Francisco county from 2011 to 2015, we identified a profile of safety threats that accounts for why workers are more likely to determine children of parents with mental illness and/or substance abuse unsafe in the home. Eight percent of assessments in our sample involved parents with current mental illness only and 10% had comorbid substance abuse. The odds of an unsafe determination more than doubled among parents with mental illness (OR = 2.52, p < 0.001) and were nearly tenfold higher among parents with comorbid substance abuse (OR = 9.62, p < 0.001). Three safety threats accounted for all of the effect of parental mental illness on safety determination: caretaking impairment due to emotional stability/developmental status/cognitive deficiency (57%), failure to meet a child’s immediate needs (30%), and threats of harm (14%). Three safety threats accounted for 55% of the effect of comorbid mental illness and substance abuse on safety determination: failure to meet a child’s immediate needs (21%), presence of a drug-exposed infant (21%), and caretaking impairment due to emotional stability/developmental status/cognitive deficiency (14%). Results suggest that sustained linkage to effective mental health services and material resources at the outset of a child welfare case may help to promote faster and more likely reunification, and prevent future maltreatment.

Pharmaceutical opioid overdose deaths and the presence of witnesses

BackgroundIn the past two decades, rates of pharmaceutical opioid use and harms resulting from their use (including death) have risen. The present study identified a series of fatal opioid overdoses where there was evidence that witnesses had noted symptoms consistent with overdose, and examined associated contextual factors. MethodsA retrospective review was undertaken utilising the Coroners Court of Victoria’s Overdose Deaths Register for pharmaceutical opioid overdose deaths between 2011 and 2013. Information on the source of pharmaceutical opioids, co-contributing drugs, history of drug dependence, and mental illness was extracted and coded. ResultsPharmaceutical opioids were involved in 587 deaths, and within these, 125 cases (21%) were witnessed. The majority of these witnessed deaths (77.6%) occurred at the deceased’s residence, with the witness being a partner or unrelated acquaintance who did not realise the significance of what they were witnessing. The most common contributing pharmaceutical opioids were methadone (49.6%), codeine (32.0%), and oxycodone (19.2%), with the source more often prescribed than diverted. Co-contributing drugs were involved in 110 cases, with the most common being benzodiazepines. Evidence of current dependence and mental illness was found in 53.6% of cases. ConclusionMost pharmaceutical opioid overdose deaths with a witness present occurred in the deceased’s home, with symptoms of overdose being noted, but not acted upon. These findings support the trialling of education and/or naloxone to partners and family members of people who use pharmaceutical opioids in order to reduce overdose deaths.

Individuals with currently untreated mental illness: causal beliefs and readiness to seek help.

Many people with mental illness do not seek professional help. Beliefs about the causes of their current health problem seem relevant for initiating treatment. Our aim was to find out to what extent the perceived causes of current untreated mental health problems determine whether a person considers herself/himself as having a mental illness, perceives need for professional help and plans to seek help in the near future. In a cross-sectional study, we examined 207 untreated persons with a depressive syndrome, all fulfilling criteria for a current mental illness as confirmed with a structured diagnostic interview (Mini International Neuropsychiatric Interview). The sample was recruited in the community using adverts, flyers and social media. We elicited causal explanations for the present problem, depression literacy, self-identification as having a mental illness, perceived need for professional help, help-seeking intentions, severity of depressive symptoms (Patient Health Questionnaire - Depression), and whether respondents had previously sought mental healthcare. Most participants fulfilled diagnostic criteria for a mood disorder (n = 181, 87.4%) and/or neurotic, stress-related and somatoform disorders (n = 120, 58.0%) according to the ICD-10. N = 94 (45.4%) participants had never received mental health treatment previously. Exploratory factor analysis of a list of 25 different causal explanations resulted in five factors: biomedical causes, person-related causes, childhood trauma, current stress and unhealthy behaviour. Attributing the present problem to biomedical causes, person-related causes, childhood trauma and stress were all associated with stronger self-identification as having a mental illness. In persons who had never received mental health treatment previously, attribution to biomedical causes was related to greater perceived need and stronger help-seeking intentions. In those with treatment experience, lower attribution to person-related causes and stress were related to greater perceived need for professional help. While several causal explanations are associated with self-identification as having a mental illness, only biomedical attributions seem to be related to increase perceived need and help-seeking intentions, especially in individuals with no treatment experiences. Longitudinal studies investigating causal beliefs and help-seeking are needed to find out how causal attributions guide help-seeking behaviour. From this study it seems possible that portraying professional mental health treatment as not being restricted to biomedical problems would contribute to closing the treatment gap for mental disorders.

Sexual assault and general body injuries: A detailed cross-sectional Australian study of 1163 women

ObjectivesTo describe the frequency and severity of general body injury in women alleging recent sexual assault and then identify demographic and assault characteristics associated with injury severity. DesignCross-sectional study. SettingSexual Assault Resource Centre (SARC), Western Australia. ParticipantsTotal of 1163 women attending SARC from Jan-2009 to Mar-2015. MethodsWomen underwent a standardised medical examination and data collection by forensically trained doctors. Multivariate ordinal logistic regression analyses were performed. An algorithm was used to classify general body injuries as mild, moderate or severe. ResultsGeneral body injury was observed in 71% of women; 52%, 17% and 2% were classified as having respectively, mild, moderate and severe injuries. Moderate or severe injury was observed in 30.4% of women assaulted by intimate partners, 16.4% of women assaulted by strangers and 14.9% of women assaulted by friends/acquaintances. In regression analysis, an interaction between mental illness and assailant type existed after adjusting for age, intellectual disability, time-to-examination, number of assailants and location. Mental illness was an independent predictor for lower injury severity (adjusted odds ratio=0.5, 95% CI 0.3, 0.9) in women assaulted by strangers and higher injury severity in women assaulted by a friend/acquaintance (adjusted odds ratio=2.4, 95% CI 1.6, 3.6). While women assaulted by intimate partners had more frequent moderate-to-severe injuries than other women their current mental illness status was not associated with risk of injury severity. ConclusionThis study highlights the increased injury severity in women assaulted by intimate partners. The risk of moderate/severe injury for women with mental illness assaulted by their acquaintances was unexpected and requires further investigation.

Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses

Suicide is a major public health concern worldwide, and mental disorders have been identified as a main risk factor. Suicide is also one of the leading causes of perinatal maternal mortality, but very few studies have focused on suicide attempts (SA) in the perinatal period. This work aims to assess risk factors associated with SA in pregnancy and in the post-partum period in women with mental health disorders.Women (n = 1439) with psychiatric disorders jointly admitted with their infant to 16 psychiatric Mother-Baby Units over 10 years (2001–2010) were assessed retrospectively for the occurrence of SA in pregnancy or the postpartum period. Multinomial logistic regression was used to explore the independent impact of maternal sociodemographic characteristics, history of childhood maltreatment and abuse, current mental illness and pregnancy data on SA in pregnancy and/or postpartum.One hundred and fifty-four women (11.68%) attempted suicide: 49 in pregnancy (3.71%) and 105 (7.97%) in the post-partum period. SA in pregnancy was related to alcohol use (OR = 2.37[1.02–5.53]; p = 0.04) and smoking during pregnancy (OR = 1.87[1.01–3.49]; p = 0.04) and also to a history of miscarriage (OR = 2.29[1.18–4.41]; p = 0.01). SA in the post-partum period was associated with major depressive episode (OR = 2.72[1.40–5.26]; p = 0.003) or recurrent depression (OR = 4.12[2.25–7.51], p < 0.001) and younger age (OR = 0.96[0.93–0.99], p = 0.03).SAs in the course of pregnancy and the postpartum period have different risk factors. Special attention to risk of suicide is needed during pregnancy for women with severe mental illness and a history of miscarriage, alcohol or cigarette use, young age and depression in the perinatal period.

Youth mental ill health and secondary school completion in Australia: time to act.

This paper reviews the evidence of youth mental ill health and its impact on secondary school educational attainment. This narrative review presents the current research related to the mental ill health of young people in urban and rural Australia, their educational attainment and the effectiveness of mental health strategies implemented in secondary schools. The prevalence of mental ill health is high for Australian young people and the onset of depression, anxiety, substance-use disorders and first episode psychosis (FEP) commonly occurs when the individual is at school. The prevalence is reported to be higher for rural young people and barriers to treatment exist. Current evidence suggests that 40% of young people experiencing depression or anxiety disorders are not completing secondary school. Further evidence shows that over 50% of individuals who experience FEP do not finish secondary school. Current mental health promotion strategies employed in secondary schools have not been shown to reduce rates of depression or anxiety in adolescence nor identify prodromal or acute FEP. These strategies have not led to interventions that assist young people with mental ill health to finish school. Not completing secondary school can limit employment options, lead to severe levels of disadvantage and increased burden on welfare and healthcare systems. All young people, including those in rural areas, have the right to education and should not be disadvantaged in their educational aspirations because they have an emerging or current mental illness.

Optimising healthcare ICT support for the care and management of elderly adults with mental illness in residential aged care facilities

The global increase of adult mental illness (Dementia and Alzheimer) in the 65 years and older age group, pose unique treatment challenges to residential aged care facility staff. Current residential aged care mental illness treatment plans for elderly adults are not customised according to individual personal needs. Such customization requires inputs from multiple stakeholders i.e. mentally ill adults, carers, medical professionals and clinicians, community mental healthcare service providers, family/relatives and friends. This research aims to develop an integrated ICT framework that supports customised treatment plans for adults with mental illness in residential aged care facilities. This research-in-progress outlines initial stages of a novel methodology to better support and enable individual care and treatment of adults with mental illness in residential aged care facilities. Application of this methodology will 1) identify key information needs for individualised mental illness treatment plans, 2) integrate and consolidate multiple information sources, 3) enhance aged care facility carers’ experience and understanding of the impact of mental illness on human behaviour, and 4) implement innovative ICT solutions that support individualised care and treatment plans.

Development and validation of the Japanese version of cognitive flexibility scale.

BackgroundVarious instruments have been developed to assess cognitive flexibility, which is an important construct in psychology. Among these, the self-report cognitive flexibility scale (CFS) is particularly popular for use with English speakers; however, there is not yet a Japanese version of this scale. This study reports on the development of a Japanese version of the cognitive flexibility scale (CFS-J), and the assessment of its internal consistency, test–retest reliability, and validities.MethodsWe used the standard translation–back-translation process to develop the Japanese wording of the items and tested these using a sample of 335 eligible participants who did not have a mental illness, were aged 18 years or older, and lived in the suburbs of Tokyo. Participants included office workers, public servants, and college students; 71.6 % were women and 64.8 % were students. The translated scale’s internal consistency reliability was assessed by calculating Cronbach’s alpha and McDonald’s omega, and test–retest reliability was assessed with 107 eligible participants via intra-class correlation coefficient (ICC) and Spearman’s correlation of coefficient. Exploratory factory analysis (EFA) and correlations with other scales were used to examine the factor-based and concurrent validities of the CFS-J.ResultsResults indicated that the CFS-J has good internal consistency (Cronbach’s alpha = 0.847, McDonald’s omega = 0.871) and acceptable test–retest reliability (Spearman’s = 0.687, ICC = 0.689). EFA provided evidence that the CFS-J has a one-factor structure and factor loadings were generally appropriate. The total CFS-J score was significantly and positively correlated with the cognitive flexibility inventory-Japanese version and its two subscales, along with the cognitive control scale and the positive subscale of the short Japanese version of the automatic thought questionnaire–revised (ATQ-R); further, it had a significantly negative correlation with the negative subscale of the ATQ-R (ps < 0.001). This study developed a Japanese version of the cognitive flexibility scale and confirmed its reliability and validity among a sample of people with no current mental illness, who were living in the suburbs of Tokyo.

Educating emergency department nurses about trauma informed care for people presenting with mental health crisis: a pilot study.

BackgroundPracticing with trauma informed care (TIC) can strengthen nurses’ knowledge about the association of past trauma and the impact of trauma on the patient’s current mental illness. An aim of TIC is to avoid potentially re-traumatising a patient during their episode of care. A TIC education package can provide nurses with content that describes the interplay of neurological, biological, psychological, and social effects of trauma that may reduce the likelihood of re-traumatisation. Although mental health nurses can be TIC leads in multidisciplinary environments, the translation of TIC into clinical practice by nurses working in emergency departments (EDs) is unknown. However, before ED nurses can begin to practice TIC, they must first be provided with meaningful and specific education about TIC. Therefore, the aims of this study were to; (1) evaluate the effectiveness of TIC education for ED nursing staff and (2) describe subsequent clinical practice that was trauma informed.MethodsThis project was conducted as exploratory research with a mixed methods design. Quantitative data were collected with an 18-item pre-education and post-education questionnaire. Qualitative data were collected with two one-off focus groups conducted at least three-months after the TIC education. Two EDs were involved in the study.ResultsA total of 34 ED nurses participated in the TIC education and 14 ED nurses participated in the focus groups. There was meaningful change (p < 0.01, r ≥ 0.35) in 9 of the 18-items after TIC education. Two themes, each with two sub-themes, were evident in the data. The themes were based on the perceived effectiveness of TIC education and the subsequent changes in clinical practice in the period after TIC education.ConclusionEmergency department nurses became more informed of the interplay of trauma on an individual’s mental health. However, providing care with a TIC framework in an ED setting was a considerable challenge primarily due to time constraints relative to the day-to-day ED environment and rapid turnover of patients with potentially multiple and complex presentations. Despite this, nurses understood the effect of TIC to reduce the likelihood of re-traumatisation and expressed a desire to use a TIC framework.