Mental Health Self-management Research Articles

Supplemental Material for In Action at Work! Mental Health Self-Management Strategies for Employees Experiencing Anxiety or Depressive Symptoms

Supplemental Material for In Action at Work! Mental Health Self-Management Strategies for Employees Experiencing Anxiety or Depressive Symptoms

Reliability and validity of the Mental Health Self-management Questionnaire among Chinese patients with mood and anxiety disorders

BackgroundSelf-management plays an important role in promoting and restoring mental health for individuals with mental health issues. However, there is no valid and reliable Chinese tool assessing the self-management behaviors of people with mood and anxiety disorders. This study aimed to develop a Chinese version of the Mental Health Self-management Questionnaire (MHSQ-C) and to verify its psychometric properties.MethodsA total of 440 potential participants were recruited by convenience sampling from June to August 2020. Item analysis and analyses of internal consistency, test-retest reliability, content validity, construct validity and criterion validity were performed.ResultsData from 326 participants were used. Three factors obtained via principal component analysis and varimax rotation explained 53.68% of the total variance. The average content validity index was 0.99. The Cronbach’s α coefficient (total: 0.874, clinical: 0.706, empowerment: 0.818, vitality: 0.830) and test-retest reliability (ICC: total: 0.783, 95% confidence interval (CI) [0.616, 0.882], clinical: 0.525, 95% CI [0.240, 0.725], empowerment: 0.786, 95% CI [0.622, 0.884], vitality: 0.748, 95% CI [0.564, 0.862]) were good. The MHSQ-C was well correlated with the Partners in Health scale and showed no floor or ceiling effect.DiscussionThe MHSQ-C is a reliable and valid tool to evaluate the self-management strategies of patients with mood and anxiety disorders.

Brief Wellness Recovery Action Planning (WRAP®) as a mental health self-management tool for community adults in Hong Kong: A randomized controlled trial

Background Wellness Recovery Action Planning (WRAP ® ) is a recovery-oriented program designed for people with mental illness to improve well-being and self-manage symptoms. Aims This randomized controlled trial investigates the effectiveness of brief Wellness Recovery Action Planning (WRAP ® ) as a mental health self-management tool for adults without formal clinical diagnoses in Hong Kong. Methods 182 adults were randomly assigned to WRAP ® or waitlist control condition to investigate whether WRAP ® can promote mental well-being and reduce psychological distress for community adults with no known diagnosable mental disorders. Results Significant improvements were found in depressive (η p 2 = .11) and anxiety symptoms (η p 2 = .06), empowerment (η p 2 = .09), and personal recovery (η p 2 = .11) among WRAP ® participants compared with waitlist control participants. Moreover, changes in anxiety symptoms, hope, empowerment, and reliance on others were found to sustain at 3-month follow-up. Conclusions Brief WRAP® is an effective self-management tool in enhancing mental health and alleviating psychological distress for millennials living in the community.

Connecting Older Adults With Mental Health Apps: A Survey of Provider App and Education Material Use

Many older veterans have access to mobile devices and are interested in using apps for mental health self-management, but few have ever downloaded health apps. To address the need for awareness of and access to VA mental health apps, we developed patient educational materials aimed towards older (or novice) users of mobile devices. The present study explored health care providers’ and staff’s perceptions about use of mental health mobile applications (apps) with older veterans and examined potential utility of these patient educational materials. Requestors of mobile device education materials (N = 90) were surveyed when ordering materials and again 4 months later. Baseline and follow-up surveys assessed frequency of app recommendation, and comfort recommending apps. Baseline surveys examined perceived advantages of apps; follow-up surveys examined perceived utility of the educational materials. Descriptive statistics and qualitative analysis were conducted. Most requesters (68.5%) initially were not comfortable using apps, yet perceived many advantages to using apps and hoped materials could facilitate app use. At follow-up, requestors felt more comfortable recommending apps alongside our materials. Qualitative analysis revealed perceived advantages to using the education materials. The benefits of developing and disseminating educational materials for providers to share with older veterans helped support older veterans’ app use, and potentially increased providers’ comfort with and frequency of recommending apps to their older patients. Access to educational materials can mitigate discomfort among providers in recommending apps to older users and may bring about valuable discussions about apps which support mental health.

Exploring the Barriers to and Motivators for Using Digital Mental Health Interventions Among Construction Personnel in Nigeria: Qualitative Study.

BackgroundWork-related stress in the construction industry increases the prevalence of depression and anxiety among personnel. In low-resource settings such as Nigeria, construction personnel face high demands and severe working conditions but only have a few services to address their mental health needs. With emerging research showing that digital interventions can be used to self-manage mental health across diverse settings, there may be new opportunities to support construction personnel in the construction industry.ObjectiveThis study aims to determine the use of digital interventions for mental health management among construction personnel in Nigeria and to explore the factors that facilitate or impede the use of these interventions.MethodsThis qualitative study explored the perspectives of a convenience sample of 62 construction personnel. The data were subjected to inductive content analysis.ResultsA total of 6 barrier and 3 motivator themes were identified and categorized into 2 groups. The barrier themes were subcategorized into barriers to adoption and barriers to persistent use, whereas the motivator themes were subcategorized into intrinsic and extrinsic motivators. Lack of awareness and knowledge about the interventions may constitute a barrier to adoption and use. Participants frequently reported concerns regarding their effectiveness and usability.ConclusionsThis study provides an understanding of the design needs required to facilitate sustained self-management of mental health based on the experiences and expectations of construction personnel with digital interventions.

Comparison of face-to-face and online mindfulness-based public health interventions for older adults

BackgroundCoping with everyday stress, maintaining well-being and building up personal competencies is essential to handle today's way of living. Additionally, the actual COVID-19 pandemic also impacted the overall health of global population because of reduced social contact and other epidemiological measures. The aim of the study is to compare the effectiveness of two different approaches in conducting mindfulness-based public health interventions focused on quality of life and mental health of older adults as well as their ability to self-manage their health.MethodsIn total, 450 participants aged 65 years and older will participate in the study. Participants will be residents living in the city of Rijeka and the wider urban area consisting of six local municipalities. All engaged participants will be divided into three groups: face-to-face intervention group, online intervention group and control group. Older adults engaged in the face-to-face and online mindfulness-based intervention will participate in a seven-week workshop program base on two existing evidence-based programs: Mindfulness-based Living Programme and The Chronic Disease Self-Management Programme. The study is based on a pre-post-test design which will assess the effectiveness of public health interventions on self-efficacy in health management, social support, stress, depression, sleep, fatigue, medication use, and quality of life.ResultsResearch results will provide insight into the difference in effectiveness between two forms of implementation of public health interventions, which can be important in defining health policies regarding quality of life, mental health and health self-management of older adults.ConclusionsThis study will enable policy makers in defining future public health interventions and their adaptation to various epidemiological situations such as the one caused by the COVID-19 pandemic.Key messages Mindfulness is known as an efficient tool in maintaining personal well-being.Mindfulness can be an effective tool for improving mental health and resilience even during the COVID-19 pandemic.

Improving mental health literacy among young people aged 11\u201315\xa0years in Java, Indonesia: the co-development of a culturally-appropriate, user-centred resource (The IMPeTUs Intervention)

BackgroundMany mental health problems emerge in late childhood and contribute significantly to the global burden of disease. Adverse outcomes can extend into adulthood if left untreated. This impact is exacerbated in low- and middle-income countries where significant treatment gaps persist. Improving mental health literacy may offer an effective strategy for early intervention but remains underexplored in these contexts.MethodsAn intervention was co-developed with children and young people (CYP) by undertaking a needs analysis combined with stakeholder consensus activities. A systematic review of mental health literacy interventions in South-East Asia was undertaken in addition to semi-structured interviews with 43 children and young people (19 with and 24 without experience of anxiety and depression), 19 parents of children with experience of mental health problems and 25 education and health professionals. A focus group was also held with 8 key stakeholders immersed nationally in policy and practice. Interview schedules explored participants’ experiences of mental health, unmet needs and priorities for intervention. Data were synthesised and presented at a 3-day co-production workshop. Attendees included 13 CYP, 6 parents/guardians, 2 teachers, 8 health professionals, 2 academics and 3 game designers. Consensus exercises were utilised to identify the preferred format, content and delivery of the intervention. A smaller group of patient and public involvement contributors worked with designers to further iterate the intervention.ResultsAn immersive storyline digital application was co-developed for young people aged 11–15 with the primary aim of improving mental health literacy and self-management. The intervention comprises two chapters; one depression focussed, and the other anxiety focussed. The storyline format is interspersed with interactive games and exercises to promote engagement and encourage self-management. CYP also take part in group sessions delivered by trained facilitators before and after intervention use to discuss outcomes of and issues raised during the game.ConclusionThe IMPeTUs intervention has been co-designed for CYP aged 11–15 to improve mental health literacy and enhance self-management abilities. To the best of our knowledge, this is the first Indonesian digital intervention to improve mental health literacy and self-management for this population. Implementation, acceptability, and impact are currently being explored in a multi-site case study evaluation.

Diet, Sleep, and Mental Health: Insights from the UK Biobank Study.

Diet has long been the focus of attention as a leading risk factor for non-communicable diseases. As such, a better understanding of it is crucial to establish priorities for dietary guidelines and to inform, design, and implement strategies for preventing, helping manage, and stopping the progression of sleep and mental health-related symptoms/disorders. The aim of the current study is to conduct the largest investigation of diet, sleep, and mental health to date by utilizing the UK Biobank (UKB) dataset to identify the associations between diet and (i) sleep quality/health, and (ii) mental health symptomatology. This cross-sectional population-based study involved 502,494 middle-aged adults. UKB food frequency, sleep, and psychological factors and mental health questionnaires at baseline were used. Scores were also calculated for healthy diet, healthy sleep, mental health symptomatology, partial fibre intake, and milk intake. We observed positive associations with healthy diet and sleep and mental health, especially benefits of high intakes of vegetable, fruit, fish, water, and fibre. However, processed meat and milk intake were adversely associated with sleep and mental health. These findings make clear that there are health and wellbeing benefits and drawbacks of different diets, but do not, at this stage, demonstrate the clear causal relationships, which would support dietary interventions that might play a role in the treatment and also self-management of sleep and mental health disorders/symptoms. Further research is required to understand mechanisms of actions of which diet acts on to modulate sleep and mental health, while taking comorbidity of sleep and mental health disorders/symptoms into consideration.

An Accessible Mental Health Self-Management Innovation for College Students

This article outlines findings from two Wellness Recovery Action Plan® workshops for college students in Western Canada. Widely recognized mental health challenges among college students and a service need demonstrated in pilot sessions served as rationale for providing one of the first iterations of WRAP in a college setting.

Mobile Sensing Apps and Self-management of Mental Health During the COVID-19 Pandemic: Web-Based Survey

BackgroundDuring the COVID-19 pandemic, people had to adapt their daily life routines to the currently implemented public health measures, which is likely to have resulted in a lack of in-person social interactions, physical activity, or sleep. Such changes can have a significant impact on mental health. Mobile sensing apps can passively record the daily life routines of people, thus making them aware of maladaptive behavioral adjustments to the pandemic.ObjectiveThis study aimed to explore the views of people on mobile sensing apps that passively record behaviors and their potential to increase awareness and helpfulness for self-managing mental health during the pandemic.MethodsWe conducted an anonymous web-based survey including people with and those without mental disorders, asking them to rate the helpfulness of mobile sensing apps for the self-management of mental health during the COVID-19 pandemic. The survey was conducted in May 2020.ResultsThe majority of participants, particularly those with a mental disorder (n=106/148, 72%), perceived mobile sensing apps as very or extremely helpful for managing their mental health by becoming aware of maladaptive behaviors. The perceived helpfulness of mobile sensing apps was also higher among people who experienced a stronger health impact of the COVID-19 pandemic (β=.24; 95% CI 0.16-0.33; P<.001), had a better understanding of technology (β=.17; 95% CI 0.08-0.25; P<.001), and had a higher education (β=.1; 95% CI 0.02-0.19; P=.02).ConclusionsOur findings highlight the potential of mobile sensing apps to assist in mental health care during the pandemic.

Reducing stigma associated with mental health problems among university students in the Asia-Pacific: A video content analysis of student-driven proposals.

Studies have demonstrated that mental health problems among university students may be increasing in both prevalence and severity. This study aimed to identify ways to reduce stigma and improve students' utilization of mental health services. We performed a content analysis on video proposals to address stigma and mental health at universities, submitted by 15 teams from nine Asian-Pacific countries as part of a case competition. We examined five domains: (1) tone; (2) cultural context; (3) mental health issue of focus; (4) prevention versus secondary prevention; and (5) main intervention strategies. Five main intervention strategies emerged: (1) educational campaigns; (2) peer interaction and support; (3) counseling; (4) screening; and (5) self-management. The results suggest that mental health literacy is low among students. Educational campaigns and events to increase awareness and reduce stigma were the most commonly incorporated strategy, through film screenings, mental health days, and social media. Building empathy through personal stories from celebrities and other students was also highly recommended. Second, counseling was incorporated in 80% of proposals, with a preference for peers and staff support, and web-based therapy over professional counselors, except in severe cases. Programs to increase social contact were the third most common strategy, suggesting students may feel isolated and disconnected. Creating common spaces for students to interact and pairing of students with and without mental health issues were widely suggested. The use of technology was recommended for self-management of mental health and for mandatory mental health screening, which was generally only recommended for incoming students. Our analysis provides insight into student-generated intervention approaches to prevent and address stigma associated with mental health issues among students. A greater university commitment is needed to provide a range of resources, including education and counseling, to leverage technology, and to foster stronger support networks among students.

Mental health and diabetes self-management: assessing stakeholder perspectives from health centers in Northern Mexico

BackgroundPeople living with diabetes have an increased risk of developing mental health issues. Mexico has observed a high prevalence of people living with diabetes suffering from mental health issues, such as anxiety and depression. Self-management programs have demonstrated promise in helping participants address and prevent not only physiological health complications but mental health issues as well. This qualitative study aimed to understand the mental health benefits of a diabetes self-management intervention for health centers in Northern Mexico and opportunities for improvement through assessing stakeholder perspectives.MethodsTrained research staff used a semi-structured questionnaire guide to conduct all interviews and focus groups from February–May 2018. Individual interviews (n = 16) were conducted face-to-face at four health center sites among all health center directors and key staff located throughout the state of Sonora. One focus group (n = 41) was conducted at each of the four health centers among intervention participants. Directed content analysis was used to establish themes by understanding relationships, identifying similar experiences, and determining patterns across datasets.ResultsIn total 57 health center directors, health center staff, and intervention participants were involved in the interviews and focus groups across the four health centers. Overall the analysis identified four themes throughout the data, two were categorized as benefits and two as improvements. The primary themes for participant benefits were an increase in self-efficacy and social support to manage their chronic conditions. These were evident from not only participant perspectives, but health staff observations. Conversely, increased family involvement, and increased mental health integration and services within diabetes care were identified themes for opportunities to improve the intervention to be more inclusive and holistic.ConclusionAll stakeholders observed the benefits for intervention participants and opportunities for more inclusivity of the family and integration as well as an increase in mental health services. The themes identified demonstrated a need to more proactively enhance and utilize diabetes self-management as a means to improve mental health outcomes among people living with diabetes in Mexico. This is an opportunity to employ a more comprehensive approach to diabetes self-management, and integrate mental health services into overall diabetes care.Trial registrationwww.ClinicalTrials.gov, identifier: NCT02804698. Registered on June 17, 2016.

Facilitating the Practice of Biofeedback Via Mobile Applications and Wearable Devices for Self-Management of Mental Health

Facilitating the Practice of Biofeedback Via Mobile Applications and Wearable Devices for Self-Management of Mental Health

Disability in people with epilepsy: A nationally representative cross-sectional study

ObjectiveThe objective of this study was to explore the prevalence and predictors of limitations causing disability in patients treated for seizures or epilepsy compared with patients without epilepsy. MethodsThis was a retrospective cross-sectional study using the National Health and Nutrition Examination Survey (NHANES). We included all participants ≥20 years old for 2013–2018. We classified patients as having epilepsy if they reported taking at least one prescription medication to treat seizures or epilepsy. Physical, mental, and social limitations were determined from interview questions. We report the prevalence of any limitation and total number of limitations for participants without vs. with epilepsy using serial negative binomial regressions and severity of individual limitations according to epilepsy status. ResultsWe included 17,057 participants, of whom 148 (0.8%) had epilepsy. Overall, 80% (95% confidence interval [CI]: 73%–86%) with epilepsy vs. 38% (95% CI: 36%–39%) without epilepsy reported at least 1 limitation (p < 0.01). The mean number of limitations was 7.5 (95% CI: 6.2–8.8) for those with epilepsy vs. 2.4 (95% CI: 2.3–2.6) for those without epilepsy (p < 0.01). Epilepsy was associated with an incidence rate ratio (IRR) of 3.1 (95% CI: 2.6–3.7) in an unadjusted negative binomial regression. After adjusting for demographics and comorbidities, this association was no longer significant (IRR: 1.2, 95% CI: 0.9–1.7). Limitations cited by 40–50% of participants with epilepsy included stooping/kneeling/crouching, standing for long periods of time, and pushing/pulling objects. Limitation severity was consistently higher in patients with epilepsy. ConclusionsPatients with epilepsy had 3.1 times as many physical, mental, or social limitations compared with those without epilepsy, and disability severity was consistently higher. This effect was attenuated after considering baseline variables such as smoking and depression severity. Our work implies the importance of structured mental health screening and self-management programs targeting mood, weight, and lifestyle as potential leverage points towards alleviating epilepsy-related disability.

Social Emotional Learning in arts teacher education policy: a content analysis of assurance standards and course descriptions

Social Emotional Learning (SEL) is a unifying framework for essential life skills, including self-awareness, self-management, social awareness, relationships, and responsible decision-making. In this article, we examine the intersection of SEL competencies with national accreditation policy, state standards, and course descriptions using curricular mapping and content analysis. Our findings revealed conceptual connections with differing degrees of alignment but no explicit mention of SEL. Arts accreditation standards had SEL intersections with foundations, development, communication and relationship building, curriculum and improvement. We recommend a closer synthesis between arts teacher education and SEL through greater attention to teacher identity, mental health awareness, self-awareness, self-management, diversity, and social justice in arts teacher education policy and recognize the possibilities for enhancing K-12 arts learning.

Engaging With a Web-Based Psychosocial Intervention for Psychosis: Qualitative Study of User Experiences.

BackgroundWeb-based interventions are increasingly being used for individuals with serious mental illness, including psychosis, and preliminary evidence suggests clinical benefits. To achieve such benefits, individuals must have some level of engagement with the intervention. Currently, little is known about what influences engagement with web-based interventions for individuals with psychotic disorders.ObjectiveThis study aimed to explore users' perspectives on what influenced engagement with a web-based intervention for psychosis.MethodsA qualitative design was employed using semistructured telephone interviews. Participants were 17 adults with psychosis who had participated in a trial examining engagement with a self-guided, web-based intervention promoting personal recovery and self-management of mental health.ResultsWe identified 2 overarching themes: challenges to using the website and factors supporting persistence. Both of the main themes included several subthemes related to both user-related factors (eg, mental health, personal circumstances, approach to using the website) and users’ experience of the intervention (eg, having experienced similar content previously or finding the material confronting).ConclusionsIndividuals with psychosis experienced several challenges to ongoing engagement with a web-based intervention. Adjunctive emails present an important design feature to maintain interest and motivation to engage with the intervention. However, fluctuations in mental health and psychosocial difficulties are a significant challenge. Design and implementation considerations include flexible interventions with tailoring opportunities to accommodate changeable circumstances and individual preferences.

Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project.

Autistic adults are significantly more likely to experience co-occurring mental health conditions such as depression and anxiety. Although intervention studies are beginning to be implemented with autistic adults to address mental health outcomes, little is known about what research autistic adults feel is needed, or what mental health outcomes are of value to them. The purpose of this article is to describe a project that involved more than 350 autistic adults and other stakeholders as coproducers of research priorities on mental health. Through a variety of methods including a large online survey, two large stakeholder meetings, and three face-to-face focus groups, the project team identified five top priorities for mental health research which should be incorporated by researchers and practitioners in their work with autistic adults. These included research to inform trauma-informed care approaches; societal approaches for inclusion and acceptance of autistic individuals; community-available approaches for self-management of mental health; evaluation of adverse mental health outcomes of existing interventions; and improvements in measurement of quality of life, social well-being, and other preferred outcomes in autistic adults.Lay Autistic adults commonly experience mental health conditions. However, research rarely involves autistic adults in deciding priorities for research on mental healthcare approaches that might work for them. The purpose of this article is to describe a stakeholder-driven project that involved autistic adults in co-leading and designing research about priorities to address mental health needs. Through a large online survey, two large meetings, and three face-to-face focus group discussions involving over 350 stakeholders, we identified five priorities for mental health research desired by autistic adults. These priorities and preferred outcomes should be used to guide research and practice for autistic adults.

Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit.

Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit.

Towards Accessible Mental Healthcare through Augmented Reality and Self-Assessment Tools

Mental health presents a growing public health concern worldwide with mental illnesses affecting people’s quality of life and causing an economic impact on societies. The rapidly increasing demand for mental healthcare is calling for new ways of disseminating mental health knowledge and for supporting people with mental health illnesses. As an alternative to traditional mental health therapies and treatments, mental health self-assessment and self-management tools become widely available to the public. While such tools can potentially offer more timely personalised support, individuals seeking help are faced with the challenge of making an appropriate choice from an exhaustive number of online tools, mobile apps, and support programs.In this article, we present myGRaCE – a self-assessment and self-management mental health tool made accessible to users via Augmented Reality technologies. The advantage of the system is that it provides a direct pathway to relevant and reliable mental health resources and offers a positive incentive and interventions for at-risk users. The system offers service users the resources to gain a better understanding of their mental state and increase control of their mental health conditions via self-monitoring and self-help.

Challenges in the design, planning and implementation of trials evaluating group interventions

BackgroundGroup interventions are interventions delivered to groups of people rather than to individuals and are used in healthcare for mental health recovery, behaviour change, peer support, self-management and/or health education. Evaluating group interventions in randomised controlled trials (RCTs) presents trialists with a set of practical problems, which are not present in RCTs of one-to-one interventions and which may not be immediately obvious.MethodsCase-based approach summarising Sheffield trials unit’s experience in the design and implementation of five group interventions. We reviewed participant recruitment and attrition, facilitator training and attrition, attendance at the group sessions, group size and fidelity aspects across five RCTs.ResultsMedian recruitment across the five trials was 3.2 (range 1.7–21.0) participants per site per month. Group intervention trials involve a delay in starting the intervention for some participants, until sufficient numbers are available to start a group. There was no evidence that the timing of consent, relative to randomisation, affected post-randomisation attrition which was a matter of concern for all trial teams. Group facilitator attrition was common in studies where facilitators were employed by the health system rather than the by the grant holder and led to the early closure of one trial; research sites responded by training ‘back-up’ and new facilitators. Trials specified that participants had to attend a median of 62.5% (range 16.7%–80%) of sessions, in order to receive a ‘therapeutic dose’; a median of 76.7% (range 42.9%–97.8%) received a therapeutic dose. Across the five trials, 75.3% of all sessions went ahead without the pre-specified ideal group size. A variety of methods were used to assess the fidelity of group interventions at a group and individual level across the five trials.ConclusionThis is the first paper to provide an empirical basis for planning group intervention trials. Investigators should expect delays/difficulties in recruiting groups of the optimal size, plan for both facilitator and participant attrition, and consider how group attendance and group size affects treatment fidelity.Trial registrationISRCTN17993825 registered on 11/10/2016, ISRCTN28645428 registered on 11/04/2012, ISRCTN61215213 registered on 11/05/2011, ISRCTN67209155 registered on 22/03/2012, ISRCTN19447796 registered on 20/03/2014.