Experience Of Mental Health Difficulties Research Articles

Exploring the association between social camouflaging and self- versus caregiver-report discrepancies in anxiety and depressive symptoms in autistic and non-autistic socially anxious adolescents.

Social camouflaging or masking refers to strategies autistic individuals adopt to hide their autism persona when trying to fit in. It is unclear whether camouflaging is only applicable to social differences unique to autism, or more generally to any types of social difference, such as experiences of mental health difficulties. We asked 43 autistic and 39 non-autistic adolescents (aged 14-19 years, all of whom showed similarly high levels of social anxiety) and their primary caregivers to complete questionnaires about their mental health (anxiety and depression) and autistic traits, and adolescents self-reported camouflaging behaviours. We wondered if camouflaging may be used to hide mental health difficulties reported by young people and affect caregiver report on symptom severity. We found that adolescents who self-reported greater levels of autistic traits, anxiety and depression symptoms compared with their caregivers reported greater camouflaging. Adolescents who agreed on having high levels of autistic traits and anxiety symptoms with their caregivers reported greater camouflaging behaviours. We discuss how having high levels of autistic traits and anxiety may increase adolescents' camouflaging behaviours to hide social differences, which may contribute towards poor mental health outcomes. We think it is important to talk with adolescents about how camouflaging social and mental health difference can have negative impacts for mental health as well as possible positive social gains.

Defining young people's mental health self-care: a systematic review and co-development approach.

Self-care is among the emerging types of mental health support which operate outside traditional services, although the meaning and practice of self-care for young people with mental health difficulties are currently unclear. This systematic review was pre-registered with PROSPERO (CRD42021282510) and investigated conceptualizations of self-care in academic publications which investigated or discussed self-care for young people's mental health or wellbeing. A Patient and Public Involvement (PPI) workshop facilitated young people with experience of mental health difficulties to respond to the identified concepts and co-develop a definition of self-care. Searches in PsycINFO, MEDLINE, Embase, CINAHL Plus, Scopus, Cochrane Library of Systematic Reviews, and gray literature sources resulted in 90 included publications. Content analysis indicated little conceptual consistency, with health and wellness promotion most commonly used to define self-care. The PPI workshop co-developed a definition of mental health self-care, which attendees felt should emphasize an individual process of self-awareness, self-compassion, and specific strategies to work toward emotional balance. This study highlights the gap between current academic understandings of young people's mental health self-care and young people's experience. The presented definition will enable future research to begin from an understanding of self-care which is relevant to young people with experience of mental health difficulties.

Interventions to reduce wait times for adolescents seeking mental health services: a scoping review protocol

IntroductionThe demand for adolescent mental health services has increased significantly in recent years, leading to excessive wait times for adolescents seeking mental health services and poor mental health outcomes. Timely...

Brief acceptance and commitment therapy for shame among adults with experience of mental health difficulties using a randomized multiple baseline, single case experimental design (SCED).

Brief acceptance and commitment therapy for shame among adults with experience of mental health difficulties using a randomized multiple baseline, single case experimental design (SCED).

Perceived Nexus Between Non-Invigilated Summative Assessment and Mental Health Difficulties: A Cross Sectional Studies

The COVID-19 pandemic rapidly led to changes in the mode of teaching, learning and assessments in most tertiary institutions worldwide. Notably, non-invigilated summative assessments became predominant. These changes heightened anxiety and depression, especially among individuals with less resilient coping mechanism. We explored the perceptions and experiences of mental health difficulties of students in tertiary education regarding non-invigilated alternative assessments in comparison to invigilated assessments. A pragmatic, mixed method cross sectional design was conducted online via Qualtrics. Thematic analysis of text was carried out using NVivo 12. In the quantitative analysis, univariable and multivariable ordinal logistic models were used to examine the potential factors for preference among students in higher education. A total of 380 Nursing and Social Science students responded to the survey. Approximately 77% of students perceived non-invigilated assessments to be less stressful compared to invigilated exams. Age, course of study, stage of studies, and number of units enrolled per semester were identified as significant drivers for students’ perceived preference for non-invigilated assessments. There was an inverse relationship between the perception of stress associated with invigilated exams and the age of students. For instance, students aged between 18-24 were 5 times more likely to prefer non-invigilated exams compared to those aged 55 or more. Comparatively, students in early stages of studies had higher preference for non-invigilated assessments. However, there was a preference reversal for students enrolled in 2 or less units per semester. Social sciences students were two times more likely to prefer non-invigilated examinations to invigilated examinations compared to nursing students. The findings reinforce the use of alternative assessments in higher education as a mitigating agency to lessen the mental health burden of tertiary students in post COVID-19 era.

The Oxford Positive Self Scale: psychometric development of an assessment of cognitions associated with psychological well-being.

Developing, elaborating, and consolidating positive views of the self is a plausible route to increased psychological well-being. We set out to provide an assessment of positive self-beliefs that could be used in research and clinical practice. A non-probability online survey was conducted with 2500 UK adults, quota sampled to match the population for age, gender, ethnicity, income, and region. Exploratory factor analysis of a 94-item pool - generated with guidance from people with lived experience of mental health difficulties - was conducted to develop the Oxford Positive Self Scale (OxPos). The item pool was further reduced using regularised structural equation modelling (SEM) before confirmatory factor analysis. Optimal cut-off scores were developed using receiver operating characteristic curves. Additional validations were carried out with two further general population cohorts (n = 1399; n = 1693). A 24-item scale was developed with an excellent model fit [robust χ2 = 995.676; df = 246; CFI = 0.956; TLI = 0.951; RMSEA = 0.049 (0.047, 0.052); SRMR = 0.031]. The scale comprises four factors: mastery; strength; enjoyment; and character. SEM indicated that the scale explains 68.6% of variance in psychological well-being. The OxPos score was negatively correlated with depression (r = -0.49), anxious avoidance (r = -0.34), paranoia (r = -0.23), hallucinations (r = -0.20), and negative self-beliefs (r = -0.50), and positively correlated with psychological well-being (r = 0.79), self-esteem (r = 0.67), and positive social comparison (r = 0.72). Internal reliability and test-retest reliability were excellent. Cut-offs by age and gender were generated. A short-form was developed, explaining 96% of the full-scale variance. The new open access scale provides a psychometrically robust assessment of positive cognitions that are strongly connected to psychological well-being.

Promoting engagement with self-guided digital therapeutics for mental health: Insights from a cross-sectional survey of end-users.

Poor engagement has hindered the dissemination of self-guided digital therapeutics for mental health. Evidence on the efficacy of technology-supported strategies designed for increasing engagement with these interventions is currently inconclusive. Few studies have examined user perceptions of such strategies, which could yield key insights for enhancing their effectiveness. Two hundred and eleven participants completed a cross-sectional online survey. All participants were aged 18 years and above, living in Australia, fluent in English, and self-reported prior use of digital therapeutics for mental health needs. Survey items elicited participants'views on factor(s) contributing to their engagement/disengagement with digital therapeutics, and perceptions of engagement strategies, including: automated electronic reminders, fun facts, quizzes, and social media platforms. χ2 tests of independence were used to analyse nominal data. Inductive thematic analysis was used to analyse free-text data. Factors facilitating engagement included digestible content, assurance of confidentiality, and esthetically appealing design. Factors hindering engagement included lack of time, forgetfulness, and lack of perceived intervention efficacy. Participants had mixed views over the feasibility and acceptability of the strategies explored towardpromoting engagement. Regardless of strategy type, succinct and easily applicable content was identified as an important feature for promoting engagement. Conversely, content that could trigger psychological distress among intervention users should be avoided. Overall, the diverse range of user perspectives highlighted that engagement strategies for any specific digital intervention should be co-designed with individuals with lived experience of mental health difficulties.

Adapting cognitive behavioural therapy for depression in later life for Irish Travellers: a case example and considerations for practice

Abstract Gypsies and Travellers are at significantly increased risk of poor physical and mental health compared with the general population. Barriers to accessing mental health services include fear of stigma and discrimination from services, difficulties with signing up to services due to poor educational levels, and the taboo nature of mental health difficulties within the community. To the authors’ knowledge, no research has identified best practice for adapting psychological therapy to meet the needs of this community. This paper presents the case of John (pseudonym), an 80-year-old Irish Traveller, whose respiratory team referred him for psychological intervention for depression and anxiety symptoms. The psychology service was embedded within the respiratory team which enabled easy access to therapy services via an already trusted service. He received 10 sessions of cognitive behavioural therapy for depression, adapted to his age, physical health, and cultural background. His low mood was maintained by withdrawal from activities, rumination of losses, lack of confidence and avoidance of help-seeking. Treatment consisted of culturally adapted psychoeducation, behavioural activation, cognitive restructuring, and behavioural experiments to increase his activity, mood and confidence. The Patient Health Questionnaire and Generalised Anxiety Disorder Scale demonstrated improvements in both depressive and anxious symptoms at the end of therapy. The paper presents an overview of relevant literature before describing John’s case, formulation, culturally adapted intervention techniques and outcomes. Considerations to support best practice for clinicians working with Irish Travellers are made. Key learning aims (1) Integrating psychological services into physical health services has the potential to improve access to psychological support for minority groups facing multi-morbidity, such as Irish Travellers. This approach offers a less stigmatised route for individuals to receive help and involves fewer administrative processes, which may pose challenges for those with varying levels of literacy ability. (2) This case example presents initial evidence that short-term transdiagnostic cognitive behavioural therapy can be an effective intervention for reducing depression and anxiety symptoms in older people from an Irish Traveller background. (3) Successful outcomes in this case example hinged on: (a) A comprehensive formulation that considered the client’s full identity (e.g. cultural identity, intergenerational connections, cohort beliefs, physical health needs) in addition to their presenting problem. (b) Adapting the intervention to accommodate for culturally relevant aspects of the individual’s presentation. This involved modifying homework to reduce the literacy requirements, involving a trusted family member as a co-therapist, and integrating culturally relevant language into the therapy. (4) This case report underscores the scarcity of rigorous research involving Irish Traveller populations and emphasises the need for further exploration of their experiences of mental health difficulties and engagement with mental health services. Further research should actively involve Irish Travellers to identify unmet needs and explore potential adaptations for therapeutic interventions. This would help to ensure accurate representation and prevent the homogenisation of this diverse group of individuals.

Staff experiences of working alongside peer support workers in forensic mental health community teams: a qualitative study

PurposePeer support workers (PSWs) are individuals with lived experience of mental health difficulties, who apply this to support and inspire others in their recovery. The role of PSWs is relatively new within the forensic health-care service. Although there has been little time for these roles to develop, PSWs have successfully integrated into community teams. Despite perceived benefits of having these workers within a multi-disciplinary team (MDT), the views held by mental health professionals in forensic services have not yet been studied. The purpose of this research is to develop an understanding of the experiences of staff working with PSWs in a community forensic team and the impact this has on them.Design/methodology/approachStructured, individual interviews were conducted with eight mental health professionals, from a variety of disciplines, used across two community teams within forensic services. The data was examined according to thematic analysis.FindingsThe data indicated general positive attitudes held by professionals surrounding the working with PSWs, including the themes “providing alternative perspectives”, “unique relationships” and “hope”. Yet, themes concerned around “role ambiguity”, “boundaries” and “the impact on PSWs” also arose.Practical implicationsThis study provides insight into the attitudes held by members of an MDT of working with PSWs. Although seemingly positive, the lack of clarity around the role of the PSW is problematic.Originality/valueTo the best of the authors’ knowledge, this is the first study to explore the employment of PSWs in the context of UK forensic settings, highlighting the benefits and challenges of such from the perspective of staff.

A psychosocial exploration of resistances to service user involvement in United Kingdom National Health Service (NHS) mental health services.

Policy promotes the active participation of those with lived experience of mental health difficulties in UK NHS mental health services, from the level of collaborative care-planning to service delivery, leadership and development. However, research indicates different forms of resistance to the implementation of such service user involvement. This article reports the findings of a qualitative, interview-based study which used Foucauldian discourse analysis and psychoanalytic theory to understand how resistances are produced through the interplay of clinical mental health professionals' subjectivity and their organisational context. Service user involvement was found to highlight conflicts within clinicians' roles. Central to this conflict was an ambivalent relationship to the power associated with these roles. Power could protect professionals from work related stresses, but could also be used to dominate, silence and coerce service users in ways that conflicted with the core function of providing care. Whilst important, raising awareness of such conflict will arouse discomfort and resistance where psychological defences are challenged. A parallel is drawn with psychotherapeutic change, in which resistance must be understood and worked with as part of meaningful change.

What has changed in the experiences of people with mental health problems during the COVID-19 pandemic: a coproduced, qualitative interview study

PurposeWe sought to understand how the experiences of people in the UK with pre-existing mental health conditions had developed during the course of the COVID-19 pandemic.MethodsIn September–October 2020, we interviewed adults with mental health conditions pre-dating the pandemic, whom we had previously interviewed 3 months earlier. Participants had been recruited through online advertising and voluntary sector community organisations. Semi-structured qualitative interviews were conducted by telephone or video-conference by researchers with lived experience of mental health difficulties, and, following principles of thematic analysis, were analysed to explore changes over time in people’s experience of the pandemic.ResultsWe interviewed 44 people, achieving diversity of demographic characteristics (73% female, 54% White British, aged 18–75) and a range of mental health conditions and service use among our sample. Three overarching themes were derived from interviews. The first theme “spectrum of adaptation” describes how participants reacted to reduced access to formal and informal support through personal coping responses or seeking new sources of help, with varying degrees of success. The second theme describes “accumulating pressures” from pandemic-related anxieties and sustained disruption to social contact and support, and to mental health treatment. The third theme “feeling overlooked” reflects participants’ feeling of people with mental health conditions being ignored during the pandemic by policy-makers at all levels, which was compounded for people from ethnic minority communities or with physical health problems.ConclusionIn line with previous research, our study highlights the need to support marginalised groups who are at risk of increased inequalities, and to maintain crucial mental and physical healthcare and social care for people with existing mental health conditions, notwithstanding challenges of the pandemic.

Trialogue Meetings: Engaging Citizens and Fostering Communities of Wellbeing Through Collective Dialogue.

Community-based participatory approaches are widely recognized as valuable methods for improving mental health and well-being by enabling a greater sense of liberty among participants, through the development of equitable policies and practices, which accommodate a range of diverse perspectives. One such approach, “Trialogue Meetings,” has been found to encourage disclosure and dialogue surrounding mental health, facilitate the growth and development of communities in relation to people’s experience of mental health difficulties, service provider and community response. Emerging in the 1990s because of perceived and felt inequitable relations between people with lived experience of mental health difficulties, family members of people with mental health difficulties and professionals providing mental health service provision. This approach has been shown to successfully reduce stigma and discrimination and improve relations between stakeholders in community and mental health care settings. Trialogue Meetings incorporate Open Dialogue methods to allow multiple stakeholder groups to participate in conversations around a given topic and enable the creation of a common language and mutual understanding. Trialogue Meetings have added benefits of allowing individuals to express themselves better, gain a sense of relationality and community with others and address predetermined power hierarchies with prescribed responses to people’s experiences. In this perspective, we present an outline for Trialogue Meetings as a medium for enhancing wellbeing, providing a transformative empowering process for deliberate discursive practice and engaging citizens through sustained collective dialogue.

Designing for Wellbeing: An Inclusive Learning Design Approach with Student Mental Health Vignettes

Student mental health is a growing concern for universities; increasing numbers of students are experiencing wellbeing issues, and distance learners are particularly at risk. Evidence indicates that triggers for mental health difficulties can reside within higher education environments, systems and study practices, implying that a proactive, inclusive design approach should be considered to complement mental health service provision. Student vignettes that illustrate experiences of mental health difficulties in study are a valuable learning design tool; they have potential to support more inclusive practice by informing learning design. This paper explores the role learning design can play in creating learning that supports student mental wellbeing, it shares vignettes created in the study, discusses a case study of their use, and gives examples of barriers students experience and learning design considerations that may address these. This method was found to be engaging and effective in illustrating barriers and in supporting practitioners to identify learning design considerations to mitigate these.

The Right to Mental Health During the COVID-19 Pandemic

The relationship between mental health and human rights is integral and interdependent. There are clinical, social and economic reasons, as well as moral and legal obligations to advance mental health care as fundamental to human rights. Significant considerations for this matter are especially crucial when addressing the COVID-19 pandemic across the world. The aim of this research study was to analyse the responses to the ongoing pandemic, concerning the human rights of persons with psychosocial disabilities and the right to the mental health of the general population, in Lithuania. Methods included online surveys, semi-structured interviews, and a focus group. This article presents the results as a complex picture containing lived experiences of mental health difficulties of the general population, barriers to accessing the needed support and services, as well as analysis of violations of human rights. It also highlights the need for more research on the long-term consequences of the pandemic and lockdowns on the mental health of the population; also, on how human rights of persons with mental health conditions, and especially those with psychosocial disabilities, can be better ensured and protected in Lithuania.

'I think it does just opens it up and … you're not hiding it anymore': Trainee clinical psychologists' experiences of self-disclosing mental health difficulties.

Self-disclosure of experiences of mental health difficulties is a complex process, particularly within the workplace. Research shows that a significant number of trainee clinical psychologists have lived experience of mental health difficulties and thus face the dilemma of whether to disclose and how to manage self-disclosure during doctoral training. Grounded theory methodology was used to explore trainee experiences of self-disclosure of mental health difficulties during training. Twelve trainee clinical psychologists from accredited doctoral programmes in the United Kingdom participated in semi-structured interviews about their experiences of disclosure. Six core categories emerged relating to 'motivations', 'enablers', 'barriers', 'features of disclosure', 'responses' and 'impact', each of which were comprised of several further sub-categories. The model that emerged is largely consistent with research on disclosure in healthcare professions and has implications for training programmes, supervisors and trainees when engaging in conversations about lived experience.

PROFESSIONALS WITH LIVED EXPERIENCE IN MENTAL HEALTH SERVICES

There has recently been a promising increase in focus on co-production and participatory methodologies, with the views of patients and their families becoming an integral part of service development. People with lived experience of mental health difficulties also enter the mental health profession across a range of roles. Drawing upon personal reflections and recent literature, this discussion piece considers several topics relevant to professionals with lived experience including perspectives and experiences of stigma, self-awareness, self-disclosure and ethical practice. Implementing onward policies and strategies to address the barriers faced by mental health professionals with lived experience and promote a more inclusive working environment is essential.

770 Does Improving Sleep Lead to Better Mental Health? A Meta-Analysis of Randomised Controlled Trials

Abstract Introduction Sleep and mental health go hand-in-hand; however, the extent to which sleep is causally related to the experience of mental health difficulties is unclear. One way to test whether there is a causal link is to evaluate the extent to which interventions that improve sleep also improve mental health over time. Methods We conducted a systematic review and meta-analysis of 54 randomised controlled trials (N = 6,876) that reported the effects of interventions that successfully improved sleep on overall composite mental health, as well as on six specific mental health difficulties including depression, anxiety, stress, psychosis spectrum experiences, suicidal ideation, and PTSD. Results Improving sleep had a medium-sized effect on composite mental health (g+ = -0.47), and depression (g+ = -0.54), small-to-medium sized effects on anxiety (g+ = -0.40), and stress (g+ = -0.42), and small effects on positive psychosis spectrum experiences (g+ = -0.26). We also found a significant dose response relationship, in that greater improvements in sleep were associated with greater improvements in composite mental health. Conclusion Taken together, the findings suggest that sleep is causally related to the experience of mental health difficulties. Improving sleep leads to better mental health, especially for experiences of depression, anxiety, and stress. Future research might profitably consider how interventions that improve sleep be better incorporated into routine mental health care, as well as the possible mechanisms of action that might explain how sleep exerts its effects on mental health. Support (if any) This research was funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG- 0817-20027). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Improving child and youth mental health: Stakeholder perspectives from a cross-sectional survey to inform research priorities

Mental disorders in children and young people represent a significant burden of disease, requiring enhanced efforts in terms of both prevention and treatment. Directing scarce research resources to address important gaps and answer meaningful questions is critical and engaging stakeholders including young people, their family members, clinicians, academic researchers etc. is key to this process. We have embarked on a large programme of work to establish and prioritise research questions for the Cochrane Common Mental Disorders-Children and Young People Satellite. In 2019, we conducted a cross-sectional online survey with 295 participants. More than a third of respondents were young people, nearly one-half reported lived experience of mental health difficulties and more than 40% were involved in caregiving responsbilities for people experiencing mental health difficulties. Results from the ranking exercise showed respondents believe anxiety, depression and suicide are the most important issues to be addressed. Multiple factors that respondents believe can make young people vulnerable to mental disorders were described and results highlighted the need for service reforms, and strengthening parenting and educational responses as important ways to address mental disorders. We believe that identifying relevant research questions for evidence synthesis is essential to ensure that research funding is used for maximum benefit for this age group.

Understanding student mental health: difficulty, deflection and darkness

ABSTRACT With a particular focus on the experience of young people in higher education, this paper turns to the philosophical work of Cora Diamond to open up new ways of conceptualising mental health. We claim that Diamond offers a compelling insight into that experience of human difficulty so often subsumed by a medicalised vocabulary. We propose that she offers philosophically astute perceptions of the related human attempts at deflection (as when those same difficulties are avoided because of their lack of fit with the established discourse). And we situate this reading of Diamond against a broader understanding of the contemporary university as a place of institutional darkness. In developing this general discussion, we place ourselves within a very particular context. We draw on the narratives of a number of third-level students in Ireland, who shared their experiences as part of a hermeneutic phenomenological study into the lived experience of mental health difficulties.

An embodied distress: African asylum seekers' experiences of mental health difficulties while awaiting an asylum outcome in Ireland.

The mental health of asylum seekers has attracted significant interest and examination. Quantitative studies have consistently indicated that asylum seekers experience mental distress at a higher rate than both host populations and their refugee counterparts. Qualitative insight into asylum seekers' embodied experience of mental distress is limited. This qualitative narrative study aimed to explore African asylum seekers' everyday embodied experiences of mental distress. Sixteen semi-structured one-to-one interviews were conducted with African asylum seekers who had experienced mental distress and were receiving mental health care services in Ireland. Narrative data were analysed using a holistic analysis framework of narrative form and content. Participants described their everyday endurance of relentless rumination, shame, self-loathing, anger, and mistrust, and of becoming demoralised and hopeless. Study findings indicate that asylum seekers' mental distress interweaves the physical, psychological, emotional, and social realms, thus impacting on the whole of their being. Consequences for asylum seekers include feeling anaesthetised, having a severely diminished capacity to connect and interact with their external surroundings and other people, and, for some, efforts to end their life.Examinations of, and responses to, asylum seekers' mental distress must delve beyond the confines of diagnostic categorisations and codifications of symptomology. To achieve heightened understanding and efficacious interventions, we must empathetically listen and engage with asylum seekers' narratives of distress and the socio-cultural and socio-political context they inhabit.