Mental Health Outcome Measures Research Articles

Self-reported problems and functional difficulties in anxious pregnant women in Pakistan: The use of a patient-generated mental health outcome measure.

Anxiety during pregnancy affects women worldwide and is highly prevalent in Pakistan. The Psychological Outcome Profiles (PSYCHLOPS) questionnaire is an instrument used in therapy to assess patient-generated problems and the consequent functional difficulties. Using the PSYCHLOPS, we aimed to describe the type of problems and the consequent functional difficulties faced by anxious pregnant women in Pakistan. Secondarily, we sought to explore if a cognitive behavioral therapy (CBT)-based intervention brought about changes in the severity score for certain problems or functional difficulties. Anxious pregnant women were recruited from the Obstetrics/Gynecology Department of a tertiary hospital in Rawalpindi, Pakistan. Of 600 pregnant women randomized to receive a psychosocial intervention for prenatal anxiety delivered by non-specialist providers, 450 received ≥1 intervention session and were administered the PSYCHLOPS. Eight types of problems were identified; worries about the unborn baby's health and development (23%), concerns about family members (13%), and financial constraints (12%) were the most frequently reported primary problems. Severity scores between baseline and the last available therapy session indicated the largest decrease for relationship problems (mean = 2.4) and for concerns about family members (mean = 2.2). For functional difficulties, 45% of the participants reported difficulties in performing household chores, but the intervention showed the greatest decrease in severity scores for mental or emotional functional difficulties. Focus on certain types of patient-generated problems, e.g., relationship problems, could anchor therapy delivery in order to have the greatest impact. Tailored CBT-based intervention sessions have the potential to address important but neglected problems and functional difficulties in anxious pregnant women.

The effectiveness of group art therapy in a clinically heterogenous sample: Randomized controlled trial

The goal of this study was to examine the effects of group art therapy on different measures of both therapeutic processes (group cohesion and art therapy-related emotional regulation) and therapeutic outcomes (self-esteem, social state self-esteem, and distress) in a clinically heterogenous sample. This is a pretest-posttest control group design with a random allocation of participants, i.e., randomized control trial. The sample consisted of 160 patients (68.75% female) aged 14 to 73 years (M = 43.19, SD = 14.06; nART = 87, nTAU=73). Participants completed self-report measures of distress (depression, anxiety, and stress), self-esteem, social state self-esteem, group cohesion (GCQ), and self-expression and emotion regulation in art therapy (SERATS). The group art therapy lasted for six once-a-week sessions were 90 min long. GCQ and SERATS have unidimensional factor structures. The results showed that art therapy has statistically significant positive effects on group cohesion, self-esteem, and social state self-esteem, and lowering effects on anxiety as compared to active treatment-as-usual. Moreover, self-expression and emotional regulation during art therapy increased in the art therapy group. The measures of mental health outcomes and psychotherapeutic processes are meaningfully related in the art therapy group. In conclusion, this study presents some novel evidence for the benefits of art therapy.

The acceptability, practicality, implementation and efficacy of a physical and social activity intervention 'BreatheHappy' for people with long-term respiratory conditions: A feasibility study.

This study aimed to determine the feasibility of a group-based pilot programme of low-to-moderate physical activity training, education and social activities, by investigating acceptability, practicality, implementation and efficacy testing. We offer suggestions on programme adaptions for future study. People with a range of chronic respiratory diseases were invited to participate in a pilot 12week group activity programme. Activities included outdoor walking, tai-chi, education and a range of social activities. Acceptability was determined by participant experiences determined during interviews. Practicality was determined by programme and outcome measure completion, cost and adverse events. Implementation was determined according to whether the programme ran as planned. Efficacy was determined by statistical analyses of outcomes including hand grip strength, timed up and go test, COPD Helplessness Index, COPD Assessment Test, and measures of physical activity via accelerometry. Thematic analysis indicated that the "BreatheHappy" programme was acceptable. Seven of nine participants completed eight out of 10 sessions and the majority completed all outcome measures. "BreatheHappy" was therefore considered practical. The programme was not implemented as planned, with only 10 sessions running rather than the 12 intended. There was a significant increase in daily step counts (MD: 1284 95% CI: 240-2329 p: 0.024 effect size: 0.988), stepping time (MD: 16 min 95% CI: 5-27 min p: 0.011 effect size: 1.36) and daily minutes completing light physical activity (MD: 23 95% CI: 6-38 p: 0.006 effect size: 1.6). However, time spent sitting for ≥30min but ≤60min significantly increased (MD: 26 95% CI: 0.2-52min p: 0.049 effect size: 0.931), showing signs of efficacy and changing physical activity behaviour patterns. A 10-week programme of low-moderate physical activity training, education and social activities shows signs of feasibility for future research. Suggested adaptions for future study include using physical activity measures such as daily step count or light physical activity for a primary outcome, and mental health and social health related outcome measures relatable to participant's beneficial experiences of the programme. Recruitment in future studies will try and reach both those less socially active and possibly those who have completed pulmonary rehabilitation (PR). Venues should be close to efficient transport links whilst different frequencies and durations of programme delivery should be trialled. Adequate funding should be provided for both staff running the programme and blinded research staff for outcome measurement.

THE IMPACT OF CLOSING MEDICARE PART D COVERAGE GAP ON MENTAL HEALTH OF OLDER ADULTS

Abstract The ACA mandated the gradual elimination of the Medicare prescription drug coverage gap (also called the “Doughnut Hole”) beginning in 2011. This policy change can impact mental health through mechanisms such as reduction in out-of-pocket (OOP) expenses and increased access to prescription medication. However, no previous study has examined its impact on mental health outcomes of older adults on Medicare. Employing data from the Medical Expenditure Panel Survey (from 2006 to 2016), compare the mental health of Medicare beneficiaries (66-70 years; N=7,664) with that of non-Medicare beneficiaries (60-64 years; N=8,079) before versus after policy implementation. We find that the 2011 phasing out of Medicare drug coverage gap was associated with 0.86-point (p< 0.05) improvement in the Mental Component score of the Short-Form 12 Health Survey among beneficiaries. Our analysis was robust to using alternate measures of mental health outcomes (Kessler Index and PHQ-2) as well as to an alternate construction of treatment and control groups (comparing individuals aged 60-70 years on Medicare and private insurance). We find no detectable differences in the mental health of Medicare beneficiaries who already receive subsidies for costs associated with the coverage gap through the Low Income Subsidy (LIS) program. Further, we find that elimination of the doughnut hole reduced OOP expenses by $32.65 among Medicare beneficiaries in our sample. Overall, our results for mental health and OOP expenses are mainly attributable to women. This evidence highlights indirect effects of drug coverage gap elimination on mental health outcomes among Medicare beneficiaries.

Effectiveness of conditional cash transfers, subsidized child care and life skills training on adolescent mothers’ schooling, sexual and reproductive health, and mental health outcomes in Burkina Faso and Malawi: the PROMOTE Project pilot randomized controlled trial protocol

IntroductionGirls’ and women’s health as well as social and economic wellbeing are often negatively impacted by early childbearing. In many parts of Africa, adolescent girls who get pregnant often drop out of school, resulting in widening gender inequalities in schooling and economic participation. Few interventions have focused on education and economic empowerment of adolescent mothers in the region. We aim to conduct a pilot randomized controlled trial in Blantyre (Malawi) and Ouagadougou (Burkina Faso) to examine the acceptability and feasibility of three interventions in improving educational and health outcomes among adolescent mothers and to estimate the effect and cost-effectiveness of the three interventions in facilitating (re)entry into school or vocational training. We will also test the effect of the interventions on their sexual and reproductive health (SRH) and mental health.InterventionsThe three interventions we will assess are: a cash transfer conditioned on (re)enrolment into school or vocational training, subsidized childcare, and life skills training offered through adolescent mothers’ clubs. The life skills training will cover nurturing childcare, SRH, mental health, and financial literacy. Community health workers will facilitate the clubs. Each intervention will be implemented for 12 months.MethodsWe will conduct a baseline survey among adolescent mothers aged 10–19 years (N = 270, per site) enrolled following a household listing in select enumeration areas in each site. Adolescent mothers will be interviewed using a structured survey adapted from a previous survey on the lived experiences of pregnant and parenting adolescents in the two sites. Following the baseline survey, adolescent mothers will be individually randomly assigned to one of three study arms: arm one (adolescent mothers’ clubs only); arm two (adolescent mothers’ clubs + subsidized childcare), and arm three (adolescent mothers’ clubs + subsidized childcare + cash transfer). At endline, we will re-administer the structured survey and assess the average treatment effect across the three groups following intent-to-treat (ITT) analysis, comparing school or vocational training attendance during the intervention period. We will also compare baseline and endline measures of SRH and mental health outcomes. Between the baseline and endline survey, we will conduct a process evaluation to examine the acceptability and feasibility of the interventions and to track the implementation of the interventions.DiscussionOur research will generate evidence that provides insights on interventions that can enable adolescent mothers to continue their education, as well as improve their SRH and mental health. We aim to maximize the translation of the evidence into policy and action through sustained engagement from inception with key stakeholders and decision makers and strategic communication of research findings.Trial registration number AEARCTR-0009115, May 15, 2022.

User Engagement Clusters of an 8-Week Digital Mental Health Intervention Guided by a Relational Agent (Woebot): Exploratory Study.

With the proliferation of digital mental health interventions (DMHIs) guided by relational agents, little is known about the behavioral, cognitive, and affective engagement components associated with symptom improvement over time. Obtaining a better understanding could lend clues about recommended use for particular subgroups of the population, the potency of different intervention components, and the mechanisms underlying the intervention's success. This exploratory study applied clustering techniques to a range of engagement indicators, which were mapped to the intervention's active components and the connect, attend, participate, and enact (CAPE) model, to examine the prevalence and characterization of each identified cluster among users of a relational agent-guided DMHI. We invited adults aged 18 years or older who were interested in using digital support to help with mood management or stress reduction through social media to participate in an 8-week DMHI guided by a natural language processing-supported relational agent, Woebot. Users completed assessments of affective and cognitive engagement, working alliance as measured by goal and task working alliance subscale scores, and enactment (ie, application of therapeutic recommendations in real-world settings). The app passively collected data on behavioral engagement (ie, utilization). We applied agglomerative hierarchical clustering analysis to the engagement indicators to identify the number of clusters that provided the best fit to the data collected, characterized the clusters, and then examined associations with baseline demographic and clinical characteristics as well as mental health outcomes at week 8. Exploratory analyses (n=202) supported 3 clusters: (1) "typical utilizers" (n=81, 40%), who had intermediate levels of behavioral engagement; (2) "early utilizers" (n=58, 29%), who had the nominally highest levels of behavioral engagement in week 1; and (3) "efficient engagers" (n=63, 31%), who had significantly higher levels of affective and cognitive engagement but the lowest level of behavioral engagement. With respect to mental health baseline and outcome measures, efficient engagers had significantly higher levels of baseline resilience (P<.001) and greater declines in depressive symptoms (P=.01) and stress (P=.01) from baseline to week 8 compared to typical utilizers. Significant differences across clusters were found by age, gender identity, race and ethnicity, sexual orientation, education, and insurance coverage. The main analytic findings remained robust in sensitivity analyses. There were 3 distinct engagement clusters found, each with distinct baseline demographic and clinical traits and mental health outcomes. Additional research is needed to inform fine-grained recommendations regarding optimal engagement and to determine the best sequence of particular intervention components with known potency. The findings represent an important first step in disentangling the complex interplay between different affective, cognitive, and behavioral engagement indicators and outcomes associated with use of a DMHI incorporating a natural language processing-supported relational agent. ClinicalTrials.gov NCT05672745; https://classic.clinicaltrials.gov/ct2/show/NCT05672745.

Public mental health and wellbeing interventions delivered by allied health professionals (AHPs): mapping the evidence and identification of gaps. A systematic review

PurposeMental well-being is associated with positive outcomes throughout the life course. This study aims to examine interventions delivered by allied health professionals (AHPs) to alleviate community stressors adversely impacting public mental health and well-being.Design/methodology/approachReview inclusion criteria comprised experimental and qualitative process evaluations of public mental health interventions delivered by AHPs. Electronic searches in Cinahl, Embase, Medline, PsycINFO and the Cochrane Library, were combined with grey literature searches of National Institute for Health and Care Excellence public health guidance. A narrative synthesis and the Effective Public Health Practice Project appraisal tool were used to evaluate the evidence.FindingsA total of 45-articles were included in the review describing AHP-delivered interventions addressing social disadvantage, trauma, bullying, loneliness, work-related stress, transitional stress, intersectionality, pain and bereavement. No articles were identified evaluating interventions delivered by operating department practitioners or orthoptists. A conceptual map was developed summarising the stressors, and a typology of public mental health interventions defined including: place-based interventions, discrete/one-off interventions, multi-component lifestyle and social connector interventions and interventions targeting groups at risk of mental health conditions.Research limitations/implicationsMany mental health conditions begin in childhood, and a strength of the review is the life course perspective. A further strength is compiling a compendium of public mental health outcome measures used by AHPs to inform future research. The authors excluded many articles focussed on clinical interventions/populations, which did not meet review inclusion criteria. While playing a key role in delivering public mental health interventions, clinical psychologists are not defined as AHPs and were excluded from the review, and this may be construed a limitation. Given heterogeneity of study designs and interventions evaluated numerical analyses of pooled findings was not appropriate.Practical implicationsThe review highlights the breadth of community stressors on which AHPs can intervene and contribute in public mental health contexts, stressors which correspond to those identified in UK Government guidance as currently important and relevant to address. The findings can inform developing community public mental health pathways that align with the UK National Health Service (NHS) Long Term Plan, on prevention and early intervention to protect community mental health and well-being. Further can inform the NHS strategic direction for AHPs including informing ways of increasing utilisation of core AHP skills to optimise contributions in public mental health agendas.Social implicationsIt is surprising there were not more AHP delivered evaluations of interventions for other stressors important to address in public mental health settings, for example gambling, domestic violence or that used digital technology, and these are areas for future research. Future research should identify the most active/effective dimensions of multi-component interventions which could be informed by frameworks to guide complex intervention development. The relative paucity of research identified, highlights the predominant focus of research to date on interventions for clinical mental health conditions and populations. The lack of preventative approaches is evident, and an important area for future research to align with UK health and social care priorities.Originality/valueThe review highlights AHP-delivered interventions impacting diverse community stressors across the life course. The findings can inform developing public mental health pathways aligned with government health service priorities to protect mental health and well-being, prioritise prevention and early intervention and increase utilisation of AHP skills across public mental health settings.

A Scoping Review of Mental Health and Wellbeing Outcome Measures for Children and Young People: Implications for Children in Out-of-home Care

Abstract Purpose One of the challenges for mental health research is the lack of an agreed set of outcome measures that are used routinely and consistently between disciplines and across studies in order to build a more robust evidence base for how to better understand young people’s mental health and effectively address diverse needs. Methods This study involved a scoping review of reviews on consensus of the use of mental health and wellbeing measures with children and young people. We were particularly interested to identify if there are differences in measures that are recommended for children and young people with care experience including those with developmental disabilities. Findings We identified 41 reviews, of which two had a focus on child welfare settings, three on childhood trauma and 14 focused on children and young people with developmental disabilities. Overall, our review highlights a lack of consensus and a diversity of measures within the field. We identified 60 recommended measures, of which only nine were recommended by more than one review. Conclusions Our review highlights the need for greater agreement in the use of mental health outcome measures. While our review highlights that there is value in identifying measures that can be used with any child or young person, researchers need to take into account additional considerations when working with children and young people with care experience and those with developmental disabilities, to ensure measures are accessible and sensitive to their life experiences.

Factors associated with exposure to potentially morally injurious events (PMIEs) and moral injury in a clinical sample of veterans

IntroductionMoral injury is not inevitable following exposure to a potentially morally injurious event (PMIE). Since moral injury is associated with poor mental health outcomes, it is clinically important to understand when moral injury develops following PMIE exposure and when it does not. The current study explores associations between both PMIE exposure and moral injury with a range of mental health and functioning outcomes to explore possible differences in comorbidities between those who do, and those who do not go on to develop moral injury following PMIE exposure. MethodsA total of 428 treatment-seeking veterans from a national charity (Mage = 50.4, SDage = 10.9) completed an online questionnaire which included the Moral Injury Outcome Scale to assess PMIE exposure and moral injury symptoms, and measures of other mental health outcomes. ResultsIndependent t-tests revealed significant differences between mean scores on measures of common mental health difficulties (CMD, anxiety and depression), physical health problems, loneliness and complex PTSD between veterans who had experienced a PMIE and veterans who had not. The presence of caseness for CMD, physical health difficulties, anger difficulties, PTSD and CPTSD were significantly associated with moral injury, and trust and shame subscales of the MIOS. DiscussionThese findings build on previous theory and research indicating a distinction between exposure to PMIEs and moral injury. These distinctions suggest potential risk factors for developing moral injury following a PMIE and highlight the possible relevance of poor psychosocial functioning in the development of moral injury. Longitudinal research is needed to explore the observed associations further.

Understanding Problematic Gaming During the Covid-19 Pandemic in Adolescents and Adults: A Systematic Review of the Literature.

A growing body of evidence suggests that online gaming increased during the COVID-19 outbreak. This systematic review aims to summarize extant literature that reported on problematic gaming among both adolescents and adults during the pandemic and to identify available research on the bidirectional association between problematic gaming and mental health outcomes. A systematic search was carried out through PubMed, Web of Knowledge and AGRIS, Embase, Medline, PsychINFO (from January 2020 to January 2023), using keywords related to problematic gaming and mental health outcomes. Both cross-sectional and longitudinal empirical studies which used validated measures of problematic gaming and mental health outcomes during the COVID-19 pandemic were included. Twenty-five empirical articles were eligible for the current review, comprising 28,978 participants. The majority of the selected studies had cross-sectional designs. Overall, most eligible studies showed significant association between problematic gaming and negative mental health outcomes during the pandemic. Correlations were mostly found between problematic gaming, depression and anxiety. Future research focusing on the relationship between problematic gaming and mental health outcomes should go beyond the considerable weaknesses due to methodological limitations of cross-sectional design, sampling and measures.

Challenging and understanding gendered narratives: the development and validation of the transnormativity measure (TM)

Background: Transnormativity refers to the accountability structure that regulates the acceptable gender presentations, narratives, and ways of being of trans and nonbinary (TNB) individuals. Aims: The present research extends prior qualitative research on transnormativity to develop and validate the Transnormativity Measure (TM). Methods: The initial developed pool of potential items was presented to a focus groups and three content experts for review. In Study 1 (N = 497), the 69 initial items of the TM hypothesized to underly a six-factor structure were analyzed using Exploratory Factor Analysis (EFA) and construct and discriminant validity were assessed. In Study 2 (N = 540), an independent sample of TNB participants’ TM responses were subjected to Confirmatory Factor Analysis (CFA), invariance testing, and construct and predictive validity. Finally, in Study 3 (N = 107), an Interclass Correlation Coefficients 2-way mixed-effects model of the TM was assessed. Results: EFAs conducted in Study 1 revealed a two-factor structure as the best fit with 50 items removed. Conceptually there was considerable overlap in the items comprising the two factors and it was decided that one general factor should be utilized. Study 1 also provided preliminary construct and discriminant validity due to expected relations between the TM and existing measures of heteronormativity and internalized transphobia. In Study 2 findings from correlational tests of the remaining items revealed that four items were highly correlated and were removed. Subsequent CFA indicated that the one factor model fit the data well. Configural invariance was supported however metric noninvariance was found. Additionally, Study 2 results supported construct and predictive validity through correlations between the TM and measures of TNB community belonginess and mental health outcomes. Finally, Study 3 provided support for test-retest reliability. Discussion: Across three studies, the TM was found to be a valid measure of transnormativity.

Trauma-related Mental Health in the Context of the COVID-19 Pandemic: Findings from a ‘Living’ Systematic Literature Review

Introduction:This contribution is based on the findings from a ‘living’ systematic literature review seeking to understand the short and long term health impact of the COVID-19-pandemic. Emphasis is placed on the prevalence and risk factors of trauma-related mental health outcomes in the context of the pandemic. Especially when it comes to Post Traumatic Stress Disorder (PTSD), it is questionable whether exposure types that are typical to the pandemic match the essence of the disorder. Our objective is to verify whether the international literature sufficiently distinguishes pandemic related exposure from other risk factors such as social demographic characteristics and non-pandemic related exposure to threats and life events.Method:This part of the ‘living’ systematic literature review is conducted under the umbrella of the Dutch Integrated Health Monitor COVID-19. In order to guide a research-driven data collection, several databases were searched for studies published during the pandemic. At the moment of abstract submission the protocol was published in Prospero and screening was in progress. Observational, quantitative studies including a specified exposure/event and a trauma-related mental health outcome measure are included. The included studies will be categorized based on type of exposure/event. Pooled prevalence will be calculated if studies are sufficiently homogeneous.Results:In progress.Conclusion:The results from this literature review are likely going to confirm that a substantial part of the international literature is polluted with studies promising to contain information on PTSD and other trauma-related health effects of the COVID-19 pandemic, yet running short of linking symptomatology to particular types of exposure and risk factors. If this is the case, a risk exists that public health authorities are being recommended to apply preventive and curative trauma-focused interventions based on an ambiguous knowledge base. The results will be presented during the conference.

Delta-8- and Delta-9-THC Use Frequency, Use Motives, and Mental Health Outcomes

ABSTRACT Use of delta-8-THC (“delta-8”) has proliferated after the passage of the 2018 Farm Bill. Yet, research on the mental health effects of this increasingly popular cannabinoid is scant. The current study sought to examine mental health correlates of delta-8 use frequency and motives, investigate whether delta-8 use motives predict use frequency, and compare use motives and problems between delta-8 and traditional cannabis. Participants consisted of 363 self-reported delta-8 users who completed measures of delta-8 use frequency, motives, and problems that were adapted from comparable measures for cannabis, as well as measures of mental health outcomes. Delta-8 use frequency was unrelated to use problems and other mental health outcomes. Delta-8 use frequency was positively associated with social and coping motives, but negatively associated with enhancement and conformity motives. Coping and conformity motives were associated with greater depression, anxiety, insomnia, and delta-8 use problems. Participants were more likely to report coping and enhancement motives for delta-8 use compared to cannabis use, but less likely to report conformity motives. Further longitudinal research is needed to assess causality for associations between delta-8 use frequency, use motives, and mental health outcomes.

Paediatric gastroesophageal reflux disease and parental mental health: Prevalence and predictors.

The current study aimed to estimate the prevalence of common mental health difficulties in parents who have an infant with Gastroesophageal Reflux Disease (GORD), and to identify psychological predictors of parental anxiety, depression, and well-being, as a platform for subsequent intervention development. Parents of infants with GORD (N = 309) completed online psychometric measures of potential predictors (self-compassion, illness appraisals, and illness uncertainty), potential confounders (sleep quality, relationship satisfaction, social support, and infant feeding satisfaction), and mental health outcomes (anxiety, depression, and wellbeing). The outcome measures were repeated eight-weeks later (N = 103). At the first time-point, 66% of participants exceed the clinical cut off for generalised anxiety disorder and 63% exceeded that for a depressive disorder. Both had significantly reduced eights-weeks later. Greater self-compassion predicted lower anxiety and depression, and better well-being, in both cross-sectional and longitudinal data, including when all confounders were controlled for. Illness uncertainty and illness appraisals were less consistent predictors. No robust differences were found between parents of infants with silent GORD and those with GORD with visible regurgitation. Parents of infants with GORD showed high rates of anxiety and depression, which were elevated compared to those that have been found in perinatal and general population samples. Self-compassion was a consistent predictor of better mental health and has promise as a proximal intervention target. Future research could benefit from examining the efficacy of a compassion-focussed intervention in this population.

Does Coping Mediate the Relationship Between Adverse Childhood Experiences and Health Outcomes in Young Adults?

Adverse childhood experiences (ACEs) affect 22-75% of American young adults. ACEs are associated with adverse health outcomes that begin in young adulthood. Yet, scant research has examined if coping can mediate the relationship between ACEs and adverse outcomes. The current study determined if coping mediates the relationship between ACEs and body mass index (BMI), substance use, and mental health outcomes in young adults. A community sample of 100 White and 100 Black young adults 18-34 years of age participated in a cross-sectional study conducted via Zoom conferencing. Participants provided demographic data, height/weight, and completed measures of ACEs, coping, substance use, and mental health outcomes. Coping was measured using an established three-factor model consisting of adaptive, support, and disengaged coping. Structural equation modeling (SEM) examined the relationships of ACEs to outcomes as mediated by coping. Participants were predominantly female (n = 117; 58.5%) and mid-young adult (M = 25.5 years; SD = 4.1). SEM results indicated good model fit: (CMIN/df = 1.52, CFI = 0.94, RMSEA = 0.05 [90% CI = 0.03-0.07], SRMR = 0.06). Only disengaged coping mediated the ACE and substance use (β = 0.36, p = .008), smoking (β = 0.13, p = .004), and mental health (β=-0.26, p = .008) relationships. Disengaged coping styles may be a critical mechanism in developing adverse mental health and substance use outcomes among ACE-exposed individuals. Future ACE and health outcomes research should examine the role of coping. Interventions focusing on adaptive coping may improve the health of individuals exposed to ACEs.

U.S. vs. Foreign Nativity and 10-Year Trajectories of Mental Health after Traumatic Brain Injury: A Model Systems Study.

Previous research has found racial and ethnic disparities in life satisfaction, depression, and anxiety after traumatic brain injury (TBI). However, limited studies have examined differences in these variables between U.S.- and foreign-born individuals with TBI. The purpose of this study was to examine whether differences exist in mental health outcomes between U.S.- and foreign-born individuals with TBI at 1, 2, 5, and 10 years after injury, as well as examine whether demographic and injury-related characteristics account for these differences. Participants were 8289 individuals with TBI who identified as U.S.-born and 944 who identified as born outside the U.S. in the TBI Model Systems study. Participants completed measures of mental health outcomes at 1, 2, 5, and 10 years after injury. Foreign-born individuals with TBI had comparable levels of depression and anxiety trajectories to U.S.-born individuals, yet higher life satisfaction trajectories, even after controlling for demographic and injury-related variables. Rehabilitation professionals should consider in their clinical work the mechanisms that likely influence mental health outcomes among foreign-born individuals, including family-based values that increase resilience, as well as the possible under-reporting of mental health symptoms along the lines of cultural norms.

Mental health outcome measures in the Australian context: what is the problem represented to be?

BackgroundThere is growing interest in the use of routine outcome measures (ROM) in mental health services worldwide. Australia has been at the forefront of introducing ROM in public mental health services, with the aim of improving services and consumer outcomes.MethodsAn in-depth policy and document analysis was conducted using Carol Bacchi’s ‘What is the problem represented to be?’ approach to critically analyse the use of ROM. This approach was used to identify and analyse the problem representations relating to the need for, and the choice of, outcome measures in Australian public mental health services, and the potential consequences of policy and practice. Data included in the analysis were seven policy documents, four reports on the introduction of outcome measures in Australia, the Australian Mental Health Outcomes and Classifications Network website, and the content of the outcome measures themselves.ResultsTwo dominant representations of the ‘problem’ were identified: 1) the ‘problem’ of mental health service quality and accountability, relating to the need for mental health outcome measures; and 2) the ‘problem’ of addressing deficits in biopsychosocial functioning of mental health consumers, which relates to the choice of outcome measures. Framing the ‘problem’ of mental health outcomes in these ways locates the problem within individual health providers, services, and consumers, ignoring the broader socioeconomic conditions underpinning mental health and effective service provision.ConclusionsThis critical analysis of the introduction and use of ROM in public mental health services in Australia highlights the need to consider the role of the social determinants of mental health, mental health service funding, and recovery-oriented care in ensuring services are meeting consumer needs and expectations. Broader governmental engagement is central to genuine change and opportunities.

Willingness to Self-forgive as a Predictor of the Well-being of Young Students

The article considers an important and topical issue in the form of the willingness to self-forgive in young students. The concepts of psychological well-being, forgiveness, and self-forgiveness are considered. The peculiarities of the connection between psychological well-being and willingness to self-forgive in the case of young students are determined. Much attention is paid to the factors of psychological well-being. The study involved 228 people – young students, aged between 20 and 23 years, in the form of 109 men and 119 women. Empirical research was based on the following psychodiagnostic techniques: Flourishing Measure, Hardiness Test, Scale of Psychological Well-being, the Trait Forgivingness (dispositional) Scale, Mental Health Outcome Measures, Scale of Deep Readiness for Forgiveness, Depression and Anxiety (BSI – 12). The high level of willingness to self-forgive in young students is connected with high levels of hardiness and psychological well-being. The high level of willingness to self-forgive in young students is connected with low levels of anxiety and depression. It is indicated that the willingness to self-forgive is a predictor of psychological well-being in young students. The more university students are prone to willingness to self-forgive, the more they are satisfied with self-realization in specific living conditions and circumstances, with the achievement of meaningful goals, and with positive relationships with other people. The more young university students are ready for self-forgiveness, the more they are capable of reflection, the realization of their potential, the effective use of personal traits, self-acceptance, meaningful life, and being more satisfied with relationships with other people.

Indirect contact with nature, lifestyle, and mental health outcomes during mandatory hotel quarantine in Hong Kong

Background During the pandemic of COVID-19 Hong Kong lead one of the world’s longest and most stringent quarantine measures. Aims To examine cross-sectionally (i) the relationship between the duration of mandatory hotel quarantine and mental health outcomes; (ii) whether indirect contact with nature and lifestyle factors (i.e. diet, sleep, exercises, social support, and sense of meaning), mitigated this relationship. Methods A group of 248 participants under 14 or 21-d mandatory hotel quarantine in Hong Kong completed an online questionnaire that included quarantine and lifestyle-related questions, as well as mental health outcome measures. Results For those under a 21-d quarantine, there was a significant effect of the week of quarantine on the level of depressive symptoms (Patient Health Questionnaire-4), which peaked in Week 2. Worse quality of sleep, a lower sense of meaning, and a longer set (but not completed) duration of quarantine were predictors of worse mental health outcomes. The positive relationship between the day of quarantine and the level of perceived stress was moderated by the indirect contact with nature. Conclusion The results shed light on the potential negative impact of prolonged periods of quarantine on mental health outcomes and the possible protective factors.

Psychological distress, depression, anxiety, and life satisfaction following COVID-19 infection: evidence from 11 UK longitudinal population studies

BackgroundEvidence on associations between COVID-19 illness and mental health is mixed. We aimed to examine whether COVID-19 is associated with deterioration in mental health while considering pre-pandemic mental health, time since infection, subgroup differences, and confirmation of infection via self-reported test and serology data.MethodsWe obtained data from 11 UK longitudinal studies with repeated measures of mental health (psychological distress, depression, anxiety, and life satisfaction; mental health scales were standardised within each study across time) and COVID-19 status between April, 2020, and April, 2021. We included participants with information available on at least one mental health outcome measure and self-reported COVID-19 status (suspected or test-confirmed) during the pandemic, and a subset with serology-confirmed COVID-19. Furthermore, only participants who had available data on a minimum set of covariates, including age, sex, and pre-pandemic mental health were included. We investigated associations between having ever had COVID-19 and mental health outcomes using generalised estimating equations. We examined whether associations varied by age, sex, ethnicity, education, and pre-pandemic mental health, whether the strength of the association varied according to time since infection, and whether associations differed between self-reported versus confirmed (by test or serology) infection.FindingsBetween 21 Dec, 2021, and July 11, 2022, we analysed data from 54 442 participants (ranging from a minimum age of 16 years in one study to a maximum category of 90 years and older in another; including 33 200 [61·0%] women and 21 242 [39·0%] men) from 11 longitudinal UK studies. Of 40 819 participants with available ethnicity data, 36 802 (90·2%) were White. Pooled estimates of standardised differences in outcomes suggested associations between COVID-19 and subsequent psychological distress (0·10 [95% CI 0·06 to 0·13], I2=42·8%), depression (0·08 [0·05 to 0·10], I2=20·8%), anxiety (0·08 [0·05 to 0·10], I2=0·0%), and lower life satisfaction (–0·06 [–0·08 to –0·04], I2=29·2%). We found no evidence of interactions between COVID-19 and sex, education, ethnicity, or pre-pandemic mental health. Associations did not vary substantially between time since infection of less than 4 weeks, 4–12 weeks, and more than 12 weeks, and were present in all age groups, with some evidence of stronger effects in those aged 50 years and older. Participants who self-reported COVID-19 but had negative serology had worse mental health outcomes for all measures than those without COVID-19 based on serology and self-report. Participants who had positive serology but did not self-report COVID-19 did not show association with mental health outcomes.InterpretationSelf-reporting COVID-19 was longitudinally associated with deterioration in mental health and life satisfaction. Our findings emphasise the need for greater post-infection mental health service provision, given the substantial prevalence of COVID-19 in the UK and worldwide.FundingUK Medical Research Council and UK National Institute for Health and Care Research.