Onset Of Mental Health Problems Research Articles

Young people, mental health practitioners and researchers co-produce a Transition Preparation Programme to improve outcomes and experience for young people leaving Child and Adolescent Mental Health Services (CAMHS)

BackgroundIn the UK young people attending child and adolescent mental health services (CAMHS) are required to move on, either through discharge or referral to an adult service, at age 17/18, a period of increased risk for onset of mental health problems and other complex psychosocial and physical changes. CAMHS transitions are often poorly managed with negative outcomes for young people. Better preparation may improve outcomes and experience. This study aimed to co-produce, with young people who had transitioned or were facing transition from CAMHS, a CAMHS Transition Preparation Programme (TPP), deliverable in routine NHS settings.MethodsEighteen young people, aged 17–22, from three UK National Health Service (NHS) mental health foundation trusts participated in creative, participatory research workshops. Seven parents completed short questionnaires. Thirty clinical staff from two trusts took part in workshops to ensure deliverability of young people’s ideas. Young people were offered co-research opportunities.ResultsMost young people felt anxious, fearful and uncertain on leaving CAMHS and perceived mental health services as uncaring. Participants outlined transition procedures and drafted a range of preparation activities, centred around dedicated Transition Peer Support and a transition booklet, which should be offered to all CAMHS leavers, irrespective of discharge or transfer to an adult service. Preparation should aim to build confidence to help young people take responsibility for themselves and flourish in the adult world: coping or getting through it was not enough. Some clinicians also felt anxious at transition and recognised the potential impact on young people of poor communication and lack of understanding between services. Parents would appreciate help to support their offspring during the transition period. Clinicians cited lack of funding and inflexible NHS procedures and policies as potential barriers to the implementation of young people’s ideas. Nine young people took up co-research opportunities.ConclusionsMental health services underestimate the anxiety of CAMHS leavers. Young people have clear ideas about the preparation they require to leave CAMHS with the confidence to take responsibility for their own health care. Close collaboration of NHS staff and researchers facilitates the implementation of research findings.

Moderated Online Social Therapy: A Model for Reducing Stress in Carers of Young People Diagnosed with Mental Health Disorders.

Family members caring for a young person diagnosed with the onset of mental health problems face heightened stress, depression, and social isolation. Despite evidence for the effectiveness of family based interventions, sustaining access to specialist family interventions is a major challenge. The availability of the Internet provides possibilities to expand and sustain access to evidence-based psychoeducation and personal support for family members. In this paper we describe the therapeutic model and the components of our purpose-built moderated online social therapy (MOST) program for families. We outline the background to its development, beginning with our face-to-face EPISODE II family intervention, which informed our selection of therapeutic content, and the integration of recent developments in positive psychology. Our online interventions for carers integrate online therapy, online social networking, peer and expert support, and online social problem solving which has been designed to reduce stress in carers. The initial version of our application entitled Meridian was shown to be safe, acceptable, and feasible in a feasibility study of carers of youth diagnosed with depression and anxiety. There was a significant reduction in self-reported levels of stress in caregivers and change in stress was significantly correlated with use of the system. We have subsequently launched a cluster RCT for caregivers with a relative diagnosed with first-episode psychosis. Our intervention has the potential to improve access to effective specialist support for families facing the onset of serious mental health problems in their young relative.

Sleep and Mental Health in Undergraduate Students with Generally Healthy Sleep Habits.

Whereas previous research has indicated that sleep problems tend to co-occur with increased mental health issues in university students, relatively little is known about relations between sleep quality and mental health in university students with generally healthy sleep habits. Understanding relations between sleep and mental health in individuals with generally healthy sleep habits is important because (a) student sleep habits tend to worsen over time and (b) even time-limited experience of sleep problems may have significant implications for the onset of mental health problems. In the present research, 69 university students with generally healthy sleep habits completed questionnaires about sleep quality and mental health. Although participants did not report clinically concerning mental health issues as a group, global sleep quality was associated with mental health. Regression analyses revealed that nighttime sleep duration and the frequency of nighttime sleep disruptions were differentially related to total problems and clinically-relevant symptoms of psychological distress. These results indicate that understanding relations between sleep and mental health in university students with generally healthy sleep habits is important not only due to the large number of undergraduates who experience sleep problems and mental health issues over time but also due to the potential to intervene and improve mental health outcomes before they become clinically concerning.

Young people's uses of music for well-being

The period between 15 and 25 years is characterised by much personal change and is the peak age of onset of mental health problems. This prompts an interest in everyday strategies that young people might use to support their well-being. Music use is the preferred leisure activity among young people yet little is known about how music is linked to well-being in this population. This study aimed to develop and test a model of the relationships between young people's use of music and their well-being, drawing on theories from the music psychology and clinical psychology fields. A qualitative analysis of transcripts from focus groups with 11 participants aged 15–25 years revealed four ways in which music listening links with well-being: relationship building, modifying emotions, modifying cognitions and emotional immersion. These linking variables were operationalised using questionnaire scores and tested on a new sample of 107 young people. Results of a multiple mediation analysis revealed that music listening was significantly related to all four linking variables, but not directly related to well-being as measured by the Mental Health Continuum. Nevertheless, the four linking variables indirectly mediated the effect of music listening on social well-being. The findings are consistent with earlier research on the role of music in emotion regulation and social connection although there are clearly other factors involved in determining young peoples' well-being. These findings will help inform music-based interventions for young people.

How financial hardship is associated with the onset of mental health problems over time.

Poor mental health has been consistently linked with the experience of financial hardship and poverty. However, the temporal association between these factors must be clarified before hardship alleviation can be considered as an effective mental health promotion and prevention strategy. We examined whether the longitudinal associations between financial hardship and mental health problems are best explained by an individual's current or prior experience of hardship, or their underlying vulnerability. We analysed nine waves (years: 2001-2010) of nationally representative panel data from the Household, Income, and Labour Dynamics in Australia survey (n = 11,134). Two components of financial hardship (deprivation and cash-flow problems) and income poverty were coded into time-varying and time-invariant variables reflecting the contemporaneous experience of hardship (i.e., current), the prior experience of hardship (lagged/12 months), and any experience of hardship during the study period (vulnerability). Multilevel, mixed-effect logistic regression models tested the associations between these measures and mental health. Respondents who reported deprivation and cash-flow problems had greater risk of mental health problems than those who did not. Individuals vulnerable to hardship had greater risk of mental health problems, even at the times they did not report hardship. However, their risk of mental health problems was greater on occasions when they did experience hardship. The results are consistent with the argument that economic and social programmes that address and prevent hardship may promote community mental health.

Beyond dichotomies: confronting the complexity of how and why individuals come or do not come to mental health care

With up to 50% of individuals in the “developed” world and up to 85% in the “developing” world assessed to have mental health problems but receiving no treatment (1), inevitable questions arise about the reasons for the gap. There are standard explanations – issues of access, cost and manpower; issues of mental health literacy or lack thereof; and of course, the large set of issues of prejudice and discrimination that we call stigma. But the now extensive list of research correlates that have been documented across hundreds of studies have yet to unravel the subtleties that underlie the dilemma of unmet need.

A synopsis of the mental health concerns of university students: results of a text-based online survey from one Australian university

Within the university community, student demographic data highlights a high level of cultural diversity and an ‘at-risk’ population for the onset of mental health problems. Moreover, the transition to higher education is itself associated with a range of emotional, social and academic demands that can cause psychological distress. Therefore, at any one time, a substantial number of students may be attempting to complete university studies while managing problematic symptoms, behaviours or an emerging or diagnosed mental disorder. The aim of this paper is to provide a snapshot of these students' experiences to enable strategic planning of future university support services. Of particular importance was the identification of facilitators and barriers that this group of students faced while engaged in university life. Participants were 1378 students enrolled at a Western Australian university who accessed a text-based online survey during May 2009. The students provided descriptions of the range of problematic symptoms, behaviours and/or disorders that were causing interference with their lives, and university career. Not surprisingly, the most commonly identified disorders with the participant population were depression, anxiety and stress-related concerns. More than half the sample had not sought professional help. The results highlight the fact that universities are well placed to play a major role in improving pathways to primary care and early intervention for students with an emerging or diagnosed mental health problem and to identify and support students trying to manage the ‘normal’ psychological demands associated with higher education.

Childhood Family Instability and Mental Health Problems During Late Adolescence: A Test of Two Mediation Models—The TRAILS Study

This study tested whether childhood family instability is associated with mental health problems during adolescence through continued family instability and/or through a preadolescent onset of mental health problems. This test use data from a prospective population cohort of 2,230 Dutch adolescents (M age = 11.09, SD = 0.56 at the initial assessment). Childhood family instability was associated with both internalizing problems and externalizing problems during late adolescence. The association between childhood family instability and adolescent mental health problems largely disappeared when controlling for preadolescent onset of mental health problems but only slightly when controlling for continued family instability during adolescence. These patterns were comparable for both types of mental health problems but relatively stronger for internalizing problems. These results suggest that growing up in an unpredictable family environment has long-lasting negative mental health effects, most of which are due to a preadolescent onset of mental health problems.

Examining the temporal relationship between methamphetamine use and mental health comorbidity

PurposeThe aim of this paper is to examine the temporal sequencing of methamphetamine use and the onset of mental health problems among a sample of dependent methamphetamine users.Design/methodology/approachThe study used a self‐reported timeline method to examine the sequencing of first use, regular use and problematic use of methamphetamine and mental health issues among 126 users with lifetime dependence.FindingsThe majority of the sample (69 per cent) reported previous mental health diagnosis or treatment. Of this sample, 22 per cent reported mental health problems prior to their first use of methamphetamine and 72 per cent reported mental health problems after first use of methamphetamine (with the rest around the same time or unsure). On the timeline, mental health symptoms were first indicated around a year after first regular use of methamphetamine and around the same time as problematic use. Respondents identified a lag time of five years between first problematic use of methamphetamine and seeking treatment for methamphetamine‐related problems, but those that received mental health treatment engaged in methamphetamine treatment earlier.Practical implicationsAmong this sample, mental health problems coincided with problematic methamphetamine use (rather than any use) suggesting prevention efforts may be better directed at preventing transition to heavy use or use of potent forms or injecting, rather than directed at prevention of uptake. On this basis, stepped care might be appropriate for methamphetamine users.Originality/valueDespite a substantial research literature establishing the link between methamphetamine use and mental health problems, little is known about the order of onset and the implications of this for treatment. This is one of the few studies specifically investigating the temporal sequencing of methamphetamine use, mental health symptoms and treatment seeking among a sample of dependent methamphetamine users.

Difficulties in Receiving a Medical Consultation among Japanese Workers with Mental Health Problems

The aim of this study was to elucidate the factors affecting the difficulties in receiving a medical consultation among workers with mental health problems. The present study was performed using a cross-sectional survey. We requested occupational physicians and nurses who were members of the Japan Society for Occupational Health to distribute self-administered questionnaires to their clients. Ninety-nine workers (68 males and 30 females), aged 40.6 ± 9.1 yr, returned completed questionnaires; 65% of the respondents had been diagnosed with depression. The most common difficulty perceived by them was that there were no intra-office counselors. Multiple regression analysis revealed that the number of months between the onset of mental health problems and the first medical consultation was significantly associated with age and having no sick leave allowance. The implementation and enhancement of sick leave allowance may promote early intervention in regard to workplace mental health problems. Mental health education and regular checkups for older workers is also critical for early detection and intervention of mental health problems.

Home foreclosure and risk of psychiatric morbidity during the recent financial crisis

A defining feature of the US economic downturn of 2008-2010 was the alarming rate of home foreclosure. Although a substantial number of US households have experienced foreclosure since 2008, the effects of foreclosure on mental health are unknown. We examined the effects of foreclosure on psychiatric symptomatology in a prospective, population-based community survey. Data were drawn from the Detroit Neighborhoods and Health Study (DNHS), waves 1 and 2 (2008-2010). A probability sample of predominantly African-American adults in Detroit, Michigan participated (n=1547). We examined the association between home foreclosure between waves 1 and 2 and increases in symptoms of DSM-IV major depression and generalized anxiety disorder (GAD). The most common reasons for foreclosure were an increase in monthly payments, an increase in non-medical expenses and a reduction in family income. Exposure to foreclosure between waves 1 and 2 predicted symptoms of major depression and GAD at wave 2, controlling for symptoms at wave 1. Even after adjusting for wave 1 symptoms, sociodemographics, lifetime history of psychiatric disorder at wave 1 and exposure to other financial stressors between waves 1 and 2, foreclosure was associated with an increased rate of symptoms of major depression [incidence density ratio (IDR) 2.4, 95% confidence interval (CI) 1.6-3.6] and GAD (IDR 1.9, 95% CI 1.4-2.6). We provide the first prospective evidence linking foreclosure to the onset of mental health problems. These results, combined with the high rate of home foreclosure since 2008, suggest that the foreclosure crisis may have adverse effects on the mental health of the US population.

P01-301-Journey through an adolescent picu. three years on…

IntroductionThe age of onset of mental health problems is becoming younger and the severity of illness presentation throws lots of challenges for health professionals and service providers. Currently there are only four recognised Psychiatric intensive care units in England.ObjectivesLittle data is available regarding the characteristics of patients referred and treated in adolescentPICU's. This presents a challenge for clinicians and service providers for delivery of care for this patient group and developing care pathways. The main objective of this study to get a better understanding of the young people referred to help optimise care whilst in hospital and develop appropriate care pathwaysAimsThe study aims at identifying demographic, diagnostic characteristics and care pathways for young people admitted to an adolescent PICU.MethodsA retrospective case note study was undertaken of all the patients admitted over three years since opening of the adolescent PICU at Cheadle Royal hospital.ResultsData was collected from all the young people admitted to the ward between April 2007 and April 2010.Information regarding demographics including age of presentation, gender characteristics, ethnicity and area of referral were looked. The authors looked at the care pathways including reasons for referral, where admitted from, risk issues on admission, diagnostic criteria and discharge pathways.ConclusionThis study has highlighted the widely held impression that there are still gaps in adolescent crisis provisions and the need for further acute interventions. The study highlights the challenges for service providers the current gaps in care pathways for young people with multiple diagnosis and lack of adequate crisis interventions in the community.

Finding a way: a grounded theory of young people’s experience of the pathway to mental health care

Objective: The purpose of this grounded theory study was to explore how young people experienced the onset of mental health problems and to investigate their initial interactions with the health system. Design: Grounded theory was used to address the study objectives. Data were obtained through in‑depth semi‑structured interviews. Setting: Participants were recruited through two community health centres in a Sydney metropolitan area health service. Subjects: The purposive sample consisted of eight males and twelve females between the ages of eighteen and twenty-five (mean age was 21). Main outcome measures: The research identified a basic social process, a core category or central phenomenon which had the characteristics of a maze through which the participants had to struggle to find a way. The process of ‘finding a way’ has four stages. These are (a) first sign in the early stages, often involving denial or fear, and self‑medication with alcohol or other drugs; (b) recognition of the symptoms as a sign of mental illness; (c) understanding, discovering information about the illness; and (d) resolution, when care is successfully accessed. At each stage, barriers and/or facilitating factors either delay or speed progress. Conclusions: The study offers insights into the experiences of a small group of individuals and hence has limitations; however this theoretical approach provides an understanding of what ‘finding a way’ means to this group of participants and how it influences their lives. It offers a framework for understanding some of the cultural and contextual factors that affect young people’s pathways into mental health services and can inform interventions.

Culture, Children, and Mental Health Treatment: Special Section on the National Stigma Study-Children

Stigma—the prejudice and discrimination linked to individuals with mental illness—has been a mainstay of psychiatric and social science research. Yet a resurgence of academic, policy, and provider interest began in the mid-1990s and culminated in 1999 with the White House Conference on Mental Health and the first-ever Surgeon General’s report on mental illness. Interest has continued, with several programmatic efforts surrounding the recommendations of the President’s New Freedom Commission on Mental Health. As a result, we now have a solid, if not complete, knowledge base about the nature, levels, and correlates of community-based attitudes, beliefs, and behavioral dispositions toward adults with schizophrenia, depression, and addictive disorders. Importantly, no such foundation had existed on the stigma that may accompany the serious emotional disorders that children and adolescents experience or on the attitudinal barriers to and social ramifications of seeking care. Given the high level of media and professional discussion about the rise in children’s use of psychiatric medication, there is a surprising lack of empirical evidence about public perceptions of child and adolescent disorders, the parents and children who experience them, and the need for or reaction to available treatments. In the absence of such data, the tendency is to fall back on what is known about adults’ mental illness and to transfer to our research our own impressions of how cultural subgroups—for example, different racial or ethnic groups or those with more education—think and feel about medical care and the mental health system. Sociologists and other social scientists have long predicted that as modern society became more complex, allowing greater freedom in social interactions, sociodemographic characteristics would be increasingly weak substitutes for cul

Cross-national study of attitudes towards seeking professional help: Jordan, United Arab Emirates (UAE) and Arabs in Israel.

Help-seeking processes provide critical links between the onset of mental health problems and the provision of professional care. But little is known about these processes in the Arab world, and still less in transnational, comparative terms. This is the first study to compare help-seeking processes among Muslim Arab female students in Jordan, the United Arab Emirates and Israel. The present study compares the attitudes of Arab Muslim female students from Israel, Jordan and the United Arab Emirates (UAE) towards mental health treatment. A convenience sample of 262 female Muslim-Arab undergraduate university students from Jordan, United Arab Emirates (UAE) and Arab students in Israel completed a modified Orientation for Seeking Professional Help (OSPH) Questionnaire. Data revealed that nationality was not statistically significant as a variable in a positive attitude towards seeking professional help; year of study, marital status and age were found to be significant predictors of a positive attitude towards seeking help. High proportions of respondents among the nationalities referred to God through prayer during times of psychological distress. The discussion considers implications for professional service delivery and programme development. Future research could extrapolate findings to other Arab countries and to Arab peoples living in the non-Arab world.

Editorial

Editorial

Social relationships and health: the meaning of social “connectedness” and how it relates to health concerns for rural Scottish adolescents

Adolescence has been posited as an important period for the onset of mental health problems and for the need to adapt successfully to many psychosocial changes. The assumption has been made that social belonging is both a health-related goal and an antidote for other sorts of emotional crises, but there is little research on how normal adolescents themselves view connections between social relationships and their physical and mental health. This qualitative study examines how social connectedness represents both a content and process variable in northern Scottish young people's discussion of their health concerns, that is, it was both a source of distress and implicated as a helpful or harmful factor in relation to other health concerns. Analyses revealed both the potency of all of these concerns and participants' belief that skills acquired now could affect their future life goals and health. Suggestions are given for building new approaches for conceptualizing rural young people's health problems and helping them cope with the social contexts involved within and around them.

'I wanted to be a nurse ... but I didn't get that far': women with serious ongoing mental health problems speak about their lives.

Within mental health services there are fewer women than men with serious mental health problems and there is evidence that their needs are relatively neglected resulting in specific deleterious effects. In research, as in services, the abilities of women with serious mental health problems appear to be under-estimated, and there is almost a total absence of research into the views and experiences of such women. This study aimed to explore the lives of women with serious ongoing mental health problems and their experience of services, to develop understanding of the context and impact of mental distress. In a series of 5 focus group interviews, the women, who were using a range of services for people with long-term mental health problems, described lives which, even before the onset of mental health problems, were marked by material, social and personal disadvantage. Their mental health problems led to numerous losses: loss of homes, jobs, relationships, children and loss of 'normality', yet the women retained hopes and aspirations for the future. The women clearly identified aspects of the service that they valued, in particular the support and company of women workers and other women service users. The implications of these findings are discussed in relation to planning and providing mental health services for women.