Long-term Mental Health Difficulties Research Articles

Locked Up and Locked Down: How the Covid-19 Pandemic has Impacted the Mental Health of Male Prisoners and Support Staff

Background: The impact of the Covid-19 pandemic on prisons across the world has been of much concern due to the increased risk of virus spread among a particularly vulnerable population. Efforts made to prevent spread of the virus have resulted in a range of restrictive measures with the aim of reducing contact between prisoners and staff. Unfortunately, restrictions have also resulted in increased time confined to cells, reduced occupation, and restricted access to services. The potential impact of this on a population that already presents with high rates of mental health difficulties requires consideration. Male prisoners may be at particularly high risk of experiencing negative outcomes. Methods: This study evaluated the impact of the pandemic and related changes upon the mental health of prisoners and staff within a male urban prison in the United Kingdom. A mixed methods approach with a convergent parallel design was used. Correlational and feature selection analysis was conducted on quantitative data. Qualitative data were subject to a thematic analysis. Findings were integrated at the point of summary and interpretation. Results: Prisoners and staff reported finding it hard to cope with changes and stressors associated with the pandemic. For prisoners, time spent locked in one’s cell with limited access to activities and support was associated with poor mental health outcomes, and salient themes emerged of feeling trapped, isolated and neglected. For staff, concerns about prisoner welfare and worry about catching the virus was associated with increased anxiety and worry. Additionally finding it hard to cope with constant changes at work and reduced staffing resulted in unhealthy coping behaviours such as drinking and smoking. Conclusions: Findings suggest that the implementation of additional restrictions, within the already restricted prison environment, has had a significant negative impact on the mental health of both prisoners and staff. The potential long-term mental health difficulties resulting from this require further investigation, as does the likely negative impact on staff wellbeing and staff turnover. The effects of the pandemic appear to have heightened an already desperate need to consider the mental health and wellbeing of prisoners and prison staff which must be urgently addressed.

Extending Law Enforcement Reach to Children Exposed to Violence: Police Training Evaluation

Failure to immediately identify and support children exposed to violence (CEV) places them at great risk for traumatic dysregulation and long-term mental health difficulties. Police officers are in a unique position to identify and assist CEV in the immediate aftermath of exposure. Yet, law enforcement professionals do not typically receive training tailored towards effectively identifying and responding to the emotional needs of CEV. Protecting and Serving is a police training curriculum based on over two decades of successful mental health and law enforcement collaboration. The current study examined 152 police officers’ perceptions of, attitudes toward, and understanding of the training delivered at six police departments. Pre- and post-training surveys assessed the current state of practice and the effectiveness of the program presentation in three content areas: knowledge, practice, and attitude. McNemar’s test was used to evaluate pre- to post-change, chi-square analyses and one-way ANOVAs were used to assess variation associated with demographic variables, and qualitative analysis was conducted by two independent judges. Findings reflect strong officer motivation, coupled with specific gaps in knowledge and practices. Post-training results demonstrate significant gains in all three content areas. Findings underscore the need and potential utility for specialized training designed to better equip officers to respond effectively to CEV.

Effect of a Videoconference-Based Online Group Intervention for Traumatic Stress in Parents of Children With Life-threatening Illness

A substantial proportion of parents whose child is diagnosed with a life-threatening illness experience high levels of distress that can lead to long-term mental health difficulties. This can affect the child's recovery. To evaluate the efficacy of an acceptance and commitment therapy-based group intervention, delivered using videoconferencing, in reducing posttraumatic stress symptoms (PTSS) in these parents. This study was a randomized clinical trial of an intervention for parents with elevated acute stress symptoms. It was a single-site study conducted in a tertiary pediatric hospital in Australia. Parents of children aged 0 to 18 years admitted for a life-threatening illness or injury to the oncology, cardiology, or pediatric intensive care departments were eligible. Participants were screened for eligibility within the first month after diagnosis or admission and then were randomized to the intervention group or the waiting list control group 4 to 10 months after diagnosis or admission. Recruitment commenced January 2014, and final postintervention follow-up was completed in February 2018. Data analysis was performed from July to September 2018. Treatment was a psychological acceptance and commitment therapy-based group therapy program called Take a Breath, which consisted of a 6-session parent-mediated psychological intervention delivered via online videoconferences over the course of 8 weeks. Waiting list control participants received treatment as usual and were offered the intervention 3 months after randomization. The primary outcome was PTSS, as measured by the Posttraumatic Stress Disorder Checklist-Version 5 (total score range, 0-80, with higher scores indicating greater symptom severity). The PTSS was measured both before and immediately after the intervention. Changes in psychological skills taught within the intervention were also evaluated, including acceptance, mindfulness, values-based living, and psychological flexibility. Of 1232 parents who were assessed for eligibility, 313 were randomized; 161 were allocated to the waiting list control group, and 152 were allocated to the intervention group. Of those allocated, 44 parents in the waiting list group and 37 in the intervention group completed the postintervention questionnaire and were analyzed (81 participants total; mean [SD] age, 37.17 [6.43] years). Sixty-five participants (80.2%) were women, 48 participants (59.3%) were married, and 40 participants (49.4%) lived in rural or regional areas, or in a different state. In addition, 24 parents (29.6%) were in the cardiology illness group, 32 parents (39.5%) were in the oncology group, and 25 parents (30.9%) were in the pediatric intensive care unit group. The intervention group demonstrated significantly greater improvements in PTSS compared with the waiting list group (Cohen d = 1.10; 95% CI, 0.61-1.59; P = .03). The mean Posttraumatic Stress Disorder Checklist-Version 5 scores decreased from 31.7 (95% CI, 27.0-36.4) to 26.2 (95% CI, 21.8-30.7) in the waiting list control group and from 23.3 (95% CI, 18.6-28.1) to 17.8 (95% CI, 13.8-21.8) in the intervention group. The findings of this study support the use of acceptance and commitment therapy to reduce PTSS in parents of very ill children, regardless of diagnosis. These findings also suggest that a brief, group format using a videoconferencing platform can be used effectively to access hard-to-reach populations, particularly fathers and caregivers living in nonmetropolitan areas. Australian New Zealand Clinical Trials Registry Identifier: ACTRN12611000090910.

Expressed Emotion Towards Individuals with Mental and Physical Health Conditions: A Structured Literature Review

Expressed Emotion (EE) is a well-validated measure of the family environment of individuals with mental and physical conditions that examines relatives’ critical, hostile and emotionally overinvolved attitudes towards a family member with a condition. This review focuses on studies of EE on containing data of the impact of Expressed Emotion on the course of chronic illnesses and clinical outcomes in mental and physical health conditions. The structural literature review is based on the search of articles in peer-reviewed journals from 1991 to November, 2018 in the databases Psyc-Info and PubMed. Taken together, these results suggest that there is an association between EE towards patients with both physical and mental conditions and a poor clinical and personal recovery. Interestingly, the lower levels of EE towards individuals with a condition were observed in partners comparatively with parents, adult children and relatives. However, the results have been obtained only from two populations with dementia and Type I diabetes and have been considered as important issue for future research. 
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Attachment, mentalisation and expressed emotion in carers of people with long-term mental health difficulties

BackgroundExpressed emotion (EE) is a global index of familial emotional climate, which is comprised of emotional over-involvement (EOI) and critical comments (CC)/hostility. Although EE is an established predictor of negative outcomes for both people with long-term mental health difficulties and their family carers, its psychological underpinnings remain relatively poorly understood. This paper examined associations between attachment, mentalisation ability and aspects of EE.MethodsCarers of people with long-term mental health difficulties (n = 106) completed measures of adult attachment (the Experiences in Close Relationships-Short Form questionnaire), mentalisation (the Reading the Mind in the Eyes Test and the Emotional Self-Efficacy Scale) and EE (the Family Questionnaire). Data were analysed using hierarchical multiple regression.ResultsAttachment avoidance and facets of mentalisation were directly and uniquely positively associated with CC/hostility, with attachment avoidance and other-directed emotional self-efficacy (one facet of mentalisation) each significantly predicting CC/hostility scores after controlling for the effects of EOI and demographic variables. However, no associations were observed between EOI, attachment anxiety and mentalisation. Furthermore, no indirect effects from attachment to EE via mentalisation was found.ConclusionsAlthough it would be premature to propose firm clinical implications based on these findings, data indicate that it may be beneficial for clinicians to consider attachment and mentalisation in their conceptualisation of carers’ criticism and hostility. However, further research is needed to clarify the magnitude of these associations and their direction of effect before firm conclusions can be drawn.

Consequences of violence across the lifespan: Mental health and sleep quality in pregnant women.

Research has demonstrated that exposure to violence and adversity has negative effects on both mental health and biobehavioral outcomes, such as sleep health. Research examining the relationship between past and recent violence exposure and mental health suggests that the effects of childhood adversity are especially pernicious, but to date, no studies have attempted to disentangle the direct, indirect and relative effects of past year versus childhood exposure to violence and adversity on sleep. The objective of the current study was to examine the direct effects of adverse childhood experiences (ACEs) and past year intimate partner violence (IPV) on different aspects of sleep health in pregnant women. A sample of high-risk pregnant women (n = 101) were interviewed. Mediation analysis with bias-corrected, bootstrapped confidence intervals was used to evaluate direct and indirect effects. Findings indicated that while ACEs had significant direct effects on mental health, past year IPV had stronger effects on sleep quality, latency, and efficiency. ACEs did, however, indirectly affect subjective sleep quality via past year psychological IPV. These findings suggest that sleep disturbance may be a regulatory stress response that is most clearly linked to past year violence and trauma. That is, though long-term sleep disturbance may be evident following childhood adversity, it is likely that this relationship is better explained by the role of childhood adversity in predicting adulthood revictimization or due to long-term mental health difficulties associated with early trauma. (PsycINFO Database Record

Guilt, shame and expressed emotion in carers of people with long-term mental health difficulties: A systematic review

Expressed emotion (EE) is a global index of familial emotional climate, whose primary components are emotional over-involvement (EOI) and critical comments (CC)/hostility. There is a strong theoretical rationale for hypothesising that carers’ guilt and shame may be differentially associated with their EOI and CC/hostility respectively. This systematic review investigates the magnitude of these theorised associations in carers of people with long-term mental health difficulties. Electronic searches (conducted in May 2016 across Medline, CINAHL, Embase, PsycINFO and ProQuest) were supplemented with iterative hand searches. Ten papers, reporting data from eight studies, were included. Risk of bias was assessed using a standardised checklist. Relevant data were extracted and synthesised narratively. EOI was positively associated with both guilt and shame, whereas CC/hostility was positively associated with shame. The strength of associations varied depending on whether or not guilt and shame were assessed within the context of the caring relationship. Based on these data, an argument can be made for the refinement, development and evaluation of systemic and individual interventions designed to target carers’ guilt and shame. However, more research is needed to clarify the strength of these associations and their direction of effect before firm conclusions can be drawn.

An Internet-based collaboration intervention for personal recovery: How did service users and providers address and align expectations about collaboration?

Background and objective Person-centered collaboration, or partnership, between service users and providers is a vital component of recovery processes. ReConnect is an Internet intervention designed through service user involvement and aims to facilitate mental health recovery processes for persons with long-term mental health difficulties in collaboration with their providers. It has a personalized “my control panel” which depicts status → process →goals. Functionality of the intervention includes support for e.g.: social support from peers through a forum; mapping life domains; coping exercises; diary, secure messaging with health providers; crisis management and medication overview. For this paper we ask: How did the service users and their providers address and align expectations about collaboration through ReConnect? Methods: The study is inspired by action research methodology and is conducted in collaboration with a user consultant/co-researcher. Thirty two service users and their providers at different levels of care in two Norwegian municipalities pilot-tested ReConnect for at least six months. Data from a total of three focus groups and 10 interviews with service users, and three focus groups and 7 interviews with providers, were analyzed thematically and coded in NVivo. One of the themes was preliminarily coded as expectations towards and experiences with collaboration and is the main source of data for this paper. Results: The collaboration between service users and providers varied considerably in terms of whether they addressed mutual expectations at all, how they did it, whether expectations were aligned, and the degrees to which expectations changed over the course of ReConnect use. Dyads who immediately addressed expectations upon gaining access to ReConnect, and re-addressed the issue as ReConnect’s potentials and limitations became more apparent over time, appeared to be most satisfied with the intervention’s support for collaboration. For those who did not breach the topic, use of ReConnect tended to be a source of frustration and appears to have exposed pre-existing tensions in collaboration. Discussion and conclusion: The introduction of a many-faceted intervention such as ReConnect into ongoing therapeutic relationships disrupts their routine patterns of communicating and working together in ways that can be both positive and negative. Although clarifying mutual expectations would seem fundamental for any collaborative relationship regardless of technology, it was not always the case in this project. Findings suggest that proactively addressing expectations is important in determining whether the intervention enhances or undermines collaboration. Future studies should explore how tools that facilitate client-oriented therapy (e.g. The Session Rating Scale and The Outcome Rating Scale) may be incorporated into interventions like ReConnect in order to prompt such clarifications as part of collaboration.

Posttraumatic Cognitions as Mediators Between Childhood Maltreatment and Poorer Mental Health Among Young Adults

Childhood maltreatment is a significant public health issue that has been linked to a myriad of negative health consequences. To further elucidate the mechanisms of this link, the present study examined maladaptive cognitions (i.e., posttraumatic cognitions related to the self and world) and mental health sequelae among a sample of young adults. Participants were 287 undergraduate students (ages 18–29 years) who completed self-report questionnaires assessing childhood maltreatment, posttraumatic cognitions, and current mental health functioning. Data were analyzed using structural equation modeling. Findings support childhood maltreatment as an important risk factor for long-term mental health difficulties. Importantly, posttraumatic cognitions were supported as mediators in this relationship and may be useful points of intervention to mitigate mental health concerns in adulthood.

Enduring mental illness and physical health care

Research has shown that people with long-term mental health difficulties often suffer poor general health and are at risk of premature death. An audit in primary care showed that these patients had low rates of access to physical health screening and health promotion. Practices worked with colleagues in the community mental health team to encourage patients to attend for an annual check with a practice nurse. Outcomes are sent to the mental health team so that they can promote concordance with follow-up tests or treatment. Attendance rates have been high and unmet need has been revealed. Practice nurses and mental health staff are developing a better understanding of each others' roles.

Qualitative Research Methods in Psychiatric Rehabilitation

Abstract This paper will provide an overview of the qualitative research methods that have recently been applied in psychiatric rehabilitation. An introduction to the philosophical traditions, out of which qualitative research has been developed, is followed by a brief introduction to the major methodologies. Care will be taken to refer to the relevant texts, which will provide more detail about the practicalities of conducting such research. The principal areas where such methodologies may be appropriate will be described, which will include both understanding the nature of people with long-term mental health difficulties and evaluations of the service. The use of these methodologies in assessing the views and experiences of service users will be emphasized throughout. Finally, a number of specific studies that have used qualitative methods in the field of rehabilitation will be described briefly in order to provide the reader with working examples.