Face Of Illness Research Articles

A psychologist's experience of the "clinician's illusion" in the face of familial mental illness.

This first-person account focuses on the experiences of a prosumer living through the challenges of familial mental illness and addiction. The "clinician's illusion" is used to help explain feelings of shame, frustration, anger and hopelessness, particularly within the context of a broken mental health care system. Lessons learned and recommendations for other prosumers facing mental illness and addiction within their families are described. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

FOCUS mHealth Intervention for Veterans With Serious Mental Illness in an Outpatient Department of Veterans Affairs Setting: Feasibility, Acceptability, and Usability Study.

BackgroundVeterans with serious mental illnesses (SMIs) face barriers to accessing in-person evidence-based interventions that improve illness management. Mobile health (mHealth) has been demonstrated to be feasible, acceptable, effective, and engaging among individuals with SMIs in community mental health settings. mHealth for SMIs has not been tested within the Department of Veterans Affairs (VA).ObjectiveThis study examines the feasibility, acceptability, and preliminary effectiveness of an mHealth intervention for SMI in the context of VA outpatient care.MethodsA total of 17 veterans with SMIs were enrolled in a 1-month pilot trial of FOCUS, a smartphone-based self-management intervention for SMI. At baseline and posttest, they completed measures examining symptoms and functional recovery. The participants provided qualitative feedback related to the usability and acceptability of the intervention.ResultsVeterans completed on an average of 85.0 (SD 96.1) interactions with FOCUS over the 1-month intervention period. They reported high satisfaction, usability, and acceptability, with nearly all participants (16/17, 94%) reporting that they would recommend the intervention to a fellow veteran. Clinicians consistently reported finding mHealth-related updates useful for informing their care. Qualitative feedback indicated that veterans thought mHealth complemented their existing VA services well and described potential opportunities to adapt FOCUS to specific subpopulations (eg, combat veterans) as well as specific delivery modalities (eg, groups). In the 1-month period, the participants experienced small improvements in self-assessed recovery, auditory hallucinations, and quality of life.ConclusionsThe FOCUS mHealth intervention is feasible, acceptable, and usable among veterans. Future work should develop and examine VA-specific implementation approaches of FOCUS for this population.

Biathanatos revisited: Anabaptist perspectives on voluntarily stopping eating and drinking in the face of terminal illness.

IntroductionVoluntarily Stopping Eating and Drinking (VSED) is a legal means of hastening death through refusal of food and fluids – a topic rarely addressed in Christian Protestantism. Among this group, U.S. Mainline Protestants comprise nearly 15% of the population and are more likely to include social moderates and liberals who emphasize quality of life (over mere life) and may therefore be open to the practice.ObjectivesLeveraging the well-established and validated Theory of Planned Behavior – that posits a person’s intentions to carry out an action are motivated by one’s attitude, perception of subjective norms, and perceived behavioral control – this research elucidates clergy and congregants’ normative beliefs and anticipated tactical support for VSED, including their reactions to Christian-based justifications for this end-of-life option. Such reasoning includes that VSED is a “fast into eternal life” and is based on the example of Jesus Christ, who, in the face of ongoing suffering, determined the end of his own life when he stated, “It is finished,” and gave up his spirit – an insight originally argued by John Donne in Biathanatos (1647/1982).MethodsThis case study of one southern Anabaptist congregation employs a focus group and one-on-one interviews, capturing reactions to a vignette in which a hypothetical fellow parishioner intends to VSED in the face of ongoing suffering from a terminal illness.ResultsIn response to the presented vignette, study participants reported their affirmation of VSED. Responses to faith-based justifications for the practice varied widely.ConclusionIndividuals aiming to VSED in the face of terminal illness may have their intention affirmed by a church community, but will likely require additional caregiving support to achieve a hastened death. A nascent framework for future comparative studies of faith communities’ assessments of VSED is also proposed.

Association between Internalized Stigma and Self Esteem among Chronic Patients with Psychiatric Disorders

Background: People with mental illnesses face societal stigma, which limits their social chances and meaningful interactions, lowering their self-esteem, life satisfaction and impeding recovery. Aim: The study focuses on exploring the prevalence and association between internalized stigma and self esteem among patients with psychiatric disorders. Methods: This hospital-based study consisted of 360 patients diagnosed with any psychiatric disorders using a purposive sampling selected from the outpatient department (OPD) of the CIIMHANS, Dewada, Chhattisgarh, India. Patients were assessed through the socio-demographic datasheet, Internalized Stigma of Mental Illness Scale (ISMI) and the Rosenberg's Self-Esteem Scale (RSES). Results: The result of this study indicates that internalized stigma was seen to be at a severe level in just under half (42.8%) and more than half low self-esteem (54.2%) among patients with psychiatric disorders. In regression analysis, overall internalized stigma strongly contributes 75.5% to the variance on self-esteem and duration of illness. Conclusion: People who have a psychiatric illness often feel stigmatized. These people are discriminated against, have restricted work opportunities, feel stigmatized at work around the world, which lowers their self-esteem and quality of life

The face of health in the West and the East: A semio-cultural analysis

Magazines, leaflets, weblogs, and a variety of other media incessantly spread messages advising us on how to achieve or maintain our health or well-being. In such messages, the iconic representation of the face is predominant, and reveals an interesting phenomenon: the “face of health” seems to be unattainable as such, and is generally represented in a differential way, that is to say, by making reference to its opposite – the “face of illness”, or at least of malaise. In fact, the face is crucial in the medical domain: since ancient times, face observation has played an essential role in diagnostic practices, both in Western medicine (which resorts to the concept of facies, intended as the distinctive facial expression or appearance associated with a specific medical condition, for the description of pathological states) and Eastern preventive and healing techniques (within which the so-called Mian Xiang, or ‘face reading’, is fundamental, and connects the medical sphere with other aspects such as personality, talents, and dispositions). Drawing on the semiotic analysis of relevant case studies extending from classical iconography to present-day digital mediascapes, this paper investigates the representation of the face of health (and illness) across time and space, specifically focusing on the analogies and differences between the Western and the Eastern semiosphere. To this purpose, it relies on both literature concerning the representation and understanding of the face and studies on medical sign systems and discourses.

Challenges faced by mental health patients and role of community

People suffering from mental illnesses face numerous socio psychological challenges. All around the world there are policies related to proper care for people with any kind of mental illness. Improving the quality of care would positively affect behavior and intellectual abilities of patients with mental disabilities. Mental health illnesses are found in all societies but all patients do not receive effective treatments in this regard. This study was conducted to gather information about challenges faced by mental health patients and factors that support their treatment. Present research will help in increasing public awareness about various challenges of such patients and play a mediating role in filling gap regarding awareness among care givers about patients. Findings of our research also adds to the literature related to this field. For this purpose a sample of 40 participants was selected, who have faced any form of mental illness through purposive sampling technique. We found that people suffering from mental health illnesses face many social problems due to lack of awareness, such as social isolation, discrimination and identity stigmas. Challenges related to stress and depression can be avoided by providing necessary therapies such as psychotherapies, music therapies, sound therapies, professional counseling session and other interventions in the field of clinical psychology. Although many psychotherapies are available in the field to cope with mental problems but their benefit highly depend on the support of family, friends and community at large. Keywords: Behavior; Challenges; Disabilities; Issues; Mental; Social http://dx.doi.org/10.19045/bspab.2021.100131

Growing Up With Sickle Cell Disease: Hospital Medicine and Health Care Transitions.

Growing Up With Sickle Cell Disease: Hospital Medicine and Health Care Transitions.

NAMI celebrates Mental Illness Awareness Week

Last week, the National Alliance on Mental Illness (NAMI) and participants across the country advocated for better access to quality mental health care in observance of Mental Illness Awareness Week (MIAW) Oct. 3–9. Since 1990, when Congress officially established MIAW for the first full week of October, advocates have worked together to sponsor activities, large and small, to educate the public about mental illness, an Oct. 4 NAMI news release stated. NAMI highlighted its “Together for Mental Health” campaign, which focuses on the importance of improving the mental health care system, advocates stated in the release. Each day throughout the week, NAMI continued to spread awareness about some of the most common barriers to mental health care people with mental illness face. “Over the pandemic, our movement has grown stronger by the day,” said Daniel H. Gillison Jr., NAMI CEO. “We may be at an inflection point of mainstream acceptance that anyone can be vulnerable to mental health concerns. As a society, we have become more open to discussing mental health and providing support for each other.”

End of life care preference among hemodialysis population: Revisit Q methodology

ObjectiveEnd-of-life care is often overlooked in the dialysis unit despite high mortality rates. This study aimed to understand the diverse subjectivity of opinions on end-of-life care preferences, feelings, needs, value and goals in life among a haemodialysis population. MethodsThe Q methodology was used where 37 opinion statements were ranked in order of importance in a unimodal shaped grid. Results were explored using the Centroids factor extraction and Varimax rotation. ResultsFour-three persons living with haemodialysis, mean age± SD= 56.58 ± 10.22 years, participated in the study. Five-factors were identified: living in the present, family preference, self preservation, power vs. control and autonomy in decision making, loaded by eleven, four, four, three and three participants with 16 individuals not loading significantly and two were confounded. Preferences for remaining positive in the face of illness through a healthy lifestyle and preserving relationships and autonomy were demonstrated. ConclusionsEnd-of-life discussions are potentially inhibited by preferences to live for the present which should be explored in future studies. Practice implicationStatement sets may be used to help facilitate end-of-life discussions through identification of opinion groups. Establishing preferences may guide identification of those willing to initiate discussions.

Creating doorways: finding meaning and growth through art therapy in the face of life-threatening illness

ObjectivesThis article presents the findings of a pilot study situated in a tertiary care cancer centre and examines the impact of an art therapy group on the experiences of women living through breast cancer. Study designThe study design used in this study is a qualitative cross-case comparative case. MethodsTen women were interviewed about their experiences making art, many for the first time. Interviews were transcribed and analysed, along with the participants’ artist statements. ResultsCategories include the following: the significant benefits of art therapy on their sense of self-efficacy; the emotionally enhancing nature of making art for the first time; the power of their artwork to trigger insights about themselves (including subcategories of self-actualization, existential growth, and post-traumatic growth) or in communicating their experiences to loved ones; and how making art changed their worldview and life philosophies, creating doorways of possibilities. ConclusionThis study suggests that art therapy provides a safe context to reflect on profound personal changes and to re-story losses following adversity through creative practices as a dimension of care.

Cancer and severe mental illness in low- and middle-income countries: The challenges and outlook for the future.

Patients with severe mental illness (SMI) face health inequalities that lead to under treatment of diseases such as cancer and result in increased mortality. There is literature addressing this issue for SMI patients in high-income countries but few for those in low- and middle-income countries. This review aims to draw attention to the health inequalities and the compounding factors faced by SMI patients in low- and middle-income countries. The relevance of integration of psycho-oncology in the care of SMI patients with cancer is integral to reduce disparities and address varied contributory factors. The literature review was conducted by searching through two databases which includes PubMed and Google Scholar. We searched for articles using keyword search terms: severe mental illness, SMI, schizophrenia, bipolar disorder, cancer, low- middle-income countries, low- and middle-income countries, psycho-oncology, HPV vaccine, cancer incidence, cancer mortality, cancer control, cancer screening, cancer treatment and palliative care. A total of 80 research articles were included in our literature review. We found that there was an increased requirement for adapting to the changing disease landscape in low- and middle-income countries. An improvement on aspects such as vaccination, screening and prevention is necessary, and also efforts to change social stance towards SMI is crucial. There is an increase incidence of cancer in low- and middle-income countries, and the number of patients with SMI in low- and middle-income countries is also rising. This is due to social, psychological, economical and healthcare factors. Low- and middle-income countries must consider improving these aspects in order to adapt to the changing landscape.

Still 'being bothered about Billy': managing the physical health of people with severe mental illness.

People with severe mental illness (SMI) face a future not only limited by stigmatising psychiatric illness, but also a life shortened by 15–20 years through physical comorbidities. Social and behavioural determinants help explain why many of these comorbidities cluster together. Moreover, the experience of multiple conditions, sometimes with conflicting management requirements and multiple healthcare providers, creates a disproportionate treatment burden accompanied by often poorer individual disease outcomes, a situation compounded by discriminatory health care.1 The late Professor Helen Lester called upon GP colleagues to make the care of people with SMI core business in her 2012 James Mackenzie Lecture, ‘Being Bothered about Billy’, to the Royal College of General Practitioners (RCGP) Annual General Meeting. Recognising the particular contribution of cardiovascular disease (CVD) and diabetes to reduced life expectancy, Professor Lester urged GPs to ‘Don’t just screen, intervene’ for cardiometabolic risks. This advice was seemingly unheeded when GP contract negotiators retired three key cardiometabolic indicators from the 2014/2015 Quality and Outcomes Framework (QOF),2 with the predictable detrimental impact of this decision.3 While CVD remains the commonest cause of a still widening mortality gap,4 this population also experiences elevated rates of other physical comorbidities compared with the general population.5 We will argue that tackling this health inequality should remain core business for GPs. ### Why this matters to primary care In the UK, the lifetime prevalence of psychotic disorders such as schizophrenia and bipolar disorder are 0.72%6 and 1–2%7 respectively. A GP with an average list size can expect about one patient per year to present with a new psychotic illness, characterised by changes in perception, thinking, mood, and behaviour. Stigma and social isolation compound disrupted education and employment, and financial and accommodation uncertainties. About 20% of individuals will fully recover following a single episode. However, most continue to experience psychological and …

Resilience in survivors of critical illness: A scoping review of the published literature in relation to definitions, prevalence, and relationship to clinical outcomes.

Survivors of critical illness face substantial challenges in their recovery, including physical and cognitive dysfunction. Resilience is the ability to adapt and maintain one's mental health after facing such challenges. Higher resilience levels have been found to be beneficial throughout the illness trajectory in cancer patients, but resilience has not been widely researched in critical care patients. We undertook a scoping review to identify published studies on resilience following critical illness and describe: how resilience has been measured; the prevalence of low resilience in critical care patients; and what associations (if any) exist between resilience and clinical outcomes. We searched: PubMed, Medline, PsychINFO, CINAHL, Web of Science, Cochrane Library, to identify relevant studies. We found 882 unique titles: 17 were selected for full text review, 10 were considered relevant. These included ICU inpatients and survivors, and trauma and sepsis survivors. A broad critical appraisal of each study was undertaken. The overall quality of published studies was low: there was wide variation in resilience-assessment tools across the studies, including the timing of measurement; only one used a validated tool. Estimates of low resilience ranged from 28%-67%, but with varying populations, high risk of inclusion bias, and small samples. Higher resilience levels were significantly associated with lower depression, anxiety, post-traumatic stress, pain, anger, executive dysfunction, and difficulty with self-care in critical care patients and survivors. Future studies should use validated resilience assessment, determine the optimum timing, and explore prevalence, associations with outcomes, and resilience-promoting interventions in non-selected or clearly defined populations.

Transition from Acute Treatment to Survivorship: Exploring the Psychosocial Adjustments of Chinese Parents of Children with Cancer or Hematological Disorders.

Objectives: Parents of children diagnosed with critical illnesses face multiple challenges during their caregiving experience. However, relevant studies have been limited in the Chinese context. Guided by the stress and coping model, we conducted a qualitative study to identify the stressors, coping strategies, and adjustment experiences of Hong Kong parents of children with cancer or hematological disorders. Methods: We recruited 15 parents of children with cancer or hematological disorders requiring bone marrow transplantation and were currently >2 years post-treatment. They participated in a 30-min semi-structured interview. Thematic analysis was performed using the grounded theory approach. Results: The stressors reported by parents included a high caregiving burden during their children’s diagnosis and treatment stages. The fear of recurrence, the need for information, and concerns about late effects were also common among the parents during their children’s transition/survivorship stage. To cope with these stressors, the parents commonly used problem-focused (e.g., seeking help from professionals and support groups) and emotion-focused (e.g., behavioral distractions, venting, and crying) strategies. Despite these stressors, parents reported positive changes through the caregiving experience, such as improved family relationships, developing health-protective habits, and the reprioritization of different aspects of life. Conclusions: Parents encounter different stressors during the cancer care continuum. Using different coping strategies, parents experience positive changes amidst caregiving. Future studies should explore culturally relevant adaptive coping strategies to enhance parents’ psychosocial adjustment.

Care Management for Serious Mental Illness: A Systematic Review and Meta-Analysis

Persons with serious mental illness face adverse psychiatric and medical outcomes, and their care is associated with a large burden of health care costs. Care management, in which assessment, care planning, and care coordination are provided, is a common model of support, yet the evidence supporting its use among psychiatric populations is mixed. A systematic review and a meta-analysis were undertaken to determine the impact of care management on clinical outcomes, acute care utilization, cost, and satisfaction among adults with serious mental illness. A multidatabase literature search was performed. Articles were included if they compared standard outpatient care plus care management with standard outpatient care alone for adults with serious mental illness and reported on one or more predefined outcomes. Randomized controlled trials (RCTs) and other study designs were permitted for inclusion in the systematic review. The meta-analysis included only RCTs. For the systematic review, 34 articles representing 28 unique studies were included. Fifteen of these articles, representing 12 unique studies, were included in the meta-analysis, which indicated that care management was associated with small, statistically significant improvements in psychiatric symptoms, overall quality of life (QOL), and mental QOL (Hedges' g range 0.13-0.26). In addition, care management was associated with a small, statistically significant reduction in inpatient psychiatric hospital days (Hedges' g=0.16, p=0.02). Care management is associated with fewer psychiatric symptoms and greater QOL for persons with serious mental illness. Further work is needed to determine which components of the intervention are associated with effectiveness.

Exploring the Differences in Macrocognition Between Experts and Non-CHD Experts Managing Congenital Heart Disease (CHD)

Background and aims: Children with congenital heart disease (CHD) are at risk of deterioration in the face of common childhood illnesses, and their resuscitation and acute management is often best achieved with the guidance of CHD experts. Access to such expertise may be limited outside specialty heart centers and the fragility of these patients is cause for discomfort among many emergency medicine physicians. An understanding of the differences in macrocognition of these clinicians could shed light on some of the causes of discomfort and facilitate the development of a sociotechnological solution to this problem. Methods: Cardiac intensivists (CHD experts) and pediatric emergency medicine physicians (non-CHD experts) in a major academic cardiac center were interviewed using the critical decision method. Interview transcripts were coded deductively based on Klein’s macrocognitive framework and inductively to allow for new or modified characterization of dimensions. Results: While both CHD-experts and non-CHD experts relied on the macrocognitive functions of sensemaking, naturalistic decision making and detecting problems, the specific data and mental models used to understand the patients and course of therapy differed between CHD-experts and non-CHD experts. Conclusion: Characterization of differences between the macrocognitive processes of CHD experts and non-CHD experts can inform development of sociotechnological solutions to augment decision making pertaining to the acute management of pediatric CHD patients.

Individual- and System-Level Solutions for Promoting Integrated Medical Care for People with Serious Mental Illness in Public and Community Psychiatry

People with serious mental illness (SMI) face a striking mortality disparity of 10 to 28 years as compared to the general population, largely attributable to chronic and preventable disease. In this article, we highlight a few practical steps that individual psychiatrists can take to implement recommended screening, monitoring, and treatment strategies for metabolic risk parameters as well as guidance for promoting tobacco cessation. We introduce several selected multicomponent behavioral interventions with demonstrated effectiveness for obesity and diabetes in this population. The article closes with a brief overview of organizational models for collaborative care and reverse integrated care, which aim to improve health outcomes for those with SMI through a team-based approach to medical and psychiatric care—such models may be considered by service providers at the institutional level. [ Psychiatr Ann . 2021;51(6):261–265.]

The digital divide: amplifying health inequalities for people with severe mental illness in the time of COVID-19.

During COVID-19, health provision and information resources have been increasingly provided via digital means (e.g. websites, apps) and this will become a standard practice beyond the pandemic. People with severe mental illness face profound health inequalities (e.g. a >20-year mortality gap). Digital exclusion puts this population at risk of heightened or compounded inequalities. This has been referred to as the 'digital divide'. For any new digital means introduced in clinical practice to augment healthcare service provision, issues of accessibility, acceptability and usability should be addressed by researchers and developers early in the design phase, and prior to full implementation, to prevent digital exclusion.

Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic.

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population. In this narrative review, we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients: People of diverse ethnic background and color, children with disabilities, sexual and gender minorities, pregnant women, mature adults, and those patients living in urban and rural communities. The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression, anxiety and posttraumatic stress disorder symptoms. Those psychiatric patients who are ethnic minorities display barriers to care, including collective trauma and structural racism. Sexual and gender minorities with mental illness face discrimination and limited access to treatment. Pregnant women with psychiatric diagnoses show higher exposure to domestic violence. Children with disabilities face a higher risk of worsening behavior. Mature adults with psychiatric problems show depression due to social isolation. Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities, which face limited access to telehealth services. We suggest that social programs that decrease discrimination, enhance communal resilience, and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.

Knowledge and Attitude of Pharmacy Students toward People with Mental Illnesses and Help-Seeking: A Cross-Sectional Study from Saudi Arabia

People with mental illnesses (MIs) face several challenges in addition to their disease. People’s negative views of those with MIs impact patients’ decisions to seek professional help. The aims of this study were to assess pharmacy students’ attitudes toward people with MIs and seeking help for mental health, as well as their knowledge about the causes of MIs. A cross-sectional survey was conducted on pharmacy students at Unaizah College of Pharmacy, Qassim University, Saudi Arabia. Out of the 460 distributed questionnaires, 330 complete questionnaires were received, giving a response rate of 71.7%. Overall, the mean total score for attitude towards people with MIs was 60.16 ± 10.48 (maximum attainable score: 105). In this study, 51.12% believed that people with MIs are more likely to harm others than a person without MIs and 66.9% mentioned that they did not trust the work of a mentally ill person as part of their work team. However, only 35.45% believed that it is difficult for mentally ill individuals to follow social rules. In terms of attitudes toward help-seeking, the mean total score of was 12.83 ± 3.16 out of the maximum score of 25. In addition, the mean total score for knowledge about causes of mental illness was 2.92 ± 1.76 out of the maximum score of 8. The participants reported that MIs could be due to genetic inheritance (56%), substance abuse (54.5%), or brain disease (66.1%). The findings showed that there are some negative attitudes toward people with MIs and negative attitudes towards seeking help for mental health. In addition, some misconceptions about the causes of MIs are prevalent. Consequently, the incorporation of more topics concerning mental health in pharmacy curricula could help improve the awareness of and knowledge about mental health.