Psychosocial Challenges Research Articles

What to expect when girls are expecting: psychosocial support challenges and opportunities in the context and aftermath of teenage pregnancy in Kenya

BackgroundAn understanding of the psychosocial support challenges and opportunities in the context of teenage pregnancy is important for developing appropriate interventions for pregnant and parenting girls. This qualitative study was conducted in Homa Bay County, Kenya, to examine the experience of teenage pregnancy and the resultant psychosocial support needs from the perspectives of both pregnant/parenting girls and their own parents, who are typically expected to provide various forms of support.MethodsThe study used a descriptive case study design, drawing on counseling case notes documented by psychologists who held counseling sessions with 20 pregnant or parenting girls and 6 of their parents as part of a psychosocial support intervention. The counseling case notes formed a qualitative data set, which was analyzed thematically.ResultsEmerging master themes were related to pregnant and parenting girls’ experience of sexual violence and adverse childbirth outcomes; psychological trauma confronted by girls and their parents alike; parental need for support in communicating with pregnant/parenting girls about sex and sexuality; and the availability of family support as a resource for teenage mothers.ConclusionPregnant and parenting teenage girls require a range of psychosocial support responses that recognize the realities of sexual violence and other challenges in the lives of the girls themselves, as well as in the lives of their parents and caregivers. While parents and other caregivers can serve as an important resource for supporting affected girls, they often need assistance as well, in order to support pregnant/parenting girls effectively. These realities need to be taken into account to maximize the effectiveness of health and development programs for pregnant and parenting girls. Furthermore, emerging themes from actual counseling sessions with affected girls and parents can provide important insights into the potential psychosocial support needs of the broader population of pregnant and parenting girls.

AT THE INTERSECTION OF CULTURE AND MENTAL HEALTH

Abstract Although mental health disorders affect people across the lifespan, older adults face unique issues associated with accessing mental health treatment. These structural and psychosocial challenges are further exacerbated among older racial and ethnic minorities. Often compared to their white counterparts, racial and ethnic minority older adults face specific cultural factors and other systemic barriers that create stark disparities in diagnosis, treatment, and access to care. Increasing research on identifying barriers to treatment for older racial and ethnic minority adults has been recognized as an integral component in enhancing treatment access to improve behavioral health outcomes among these marginalized groups. Therefore, this review article aims to investigate the intersection of mental health and culture through the lens of three racial and ethnic minority groups in the United States – Blacks/African-Americans, Asian Americans, and Latinos. Authors provide unique insights on the differing needs of these under-researched communities by exploring psychiatric comorbidity, experiences with seeking, accessing, and engaging in treatment, and the unique cultural and psychosocial factors that affect treatment outcomes for these diverse groups. Future directions and recommendations to provide appropriate mental healthcare to Black/African-American, Asian American, and Latino communities are discussed with special attention placed on cultural adaptations, models of care, prevention, and practical strategies that can be implemented to reduce disparities and increase health equity.

YOU DON’T KNOW WHAT YOU DON’T KNOW: BLACK/LATINX CANCER SURVIVORS’ KNOWLEDGE AND USE OF SURVIVORSHIP CARE PLAN

Abstract Compared to Whites, Black and Latinx cancer survivors and their families experience disproportionate adverse effects of cancer and cancer therapy. This is due to extreme psychosocial, physical, emotional, and financial challenges they experience, thus, highlighting racial/ethnic disparity in cancer survivorship. A cancer survivorship care plan (SCP) is important for improving cancer health and quality of life, but the effectiveness of SCP as a tool to address the disproportionately persistent poor health and quality of life of Blacks/Latinx compared to Whites deserve critical attention. This study is part of a larger study on evaluating cancer survivorship in Rhode Island. We explored knowledge and use of SCP among Blacks and Latinx cancer survivors in Rhode Island. The study employed a qualitative descriptive method. Semi-structured interviews in English and Spanish were conducted with a purposive sample of 12 cancer survivors, 8 Latinx and 3 Blacks (Mage = 62 years). Their responses were transcribed and analyzed for themes. The 3 major themes identified were: 1) invisibility of survivors; 2) understanding the needs of cancer survivors; and 3) issues of empowerment. Our findings draw attention to the need for tailored interventions targeting Black/Latinx cancer survivors. One of such interventions include designing programs to increase the accessibility of SCP to help improve quality of life of cancer survivors from disadvantaged population groups.

INCREASING RISK FOR ELDER MISTREATMENT? A QUALITATIVE STUDY OF CAREGIVER EXPERIENCES DURING COVID-19

Abstract Family caregivers (CGs) of community-dwelling older adults faced unprecedented psychosocial challenges in the face of the COVID-19 pandemic. Social isolation, lack of social support, truncated care networks, financial hardship and other factors put many older adults at risk for elder mistreatment (EM). Even in normal times, incidents of EM are only identified and formally reported in about one out of every 24 cases. Social distancing restrictions in the caregiving context, including decreased access to healthcare providers, rendered older adults with higher dependency needs inordinately vulnerable to abuse and neglect. We collected qualitative data on the experiences of 24 CGs receiving telephonic support sessions between March 2020 and February 2021. Data from 100 distinct post-session case notes were analyzed using thematic content analysis to generate codes and themes. Caregivers reported rapid deterioration of care receiver’s (CRs) physical health, resulting in higher levels of dependency. Declines in mental health and cognitive impairment, including behavioral issues, were an indicator of stress for both CR and CG. CGs reported lack of access to services and social supports, fractured care networks, and increased feelings of isolation. Preliminary content analysis indicates that serious risk factors for EM were present across all 13 months of the study, and those risk factors continued or worsened over time. Findings suggest that the unintended consequences of the public health response to COVID-19 may have amplified the risk for EM in vulnerable community-dwelling older adults.

The relationship between HIV-related stigma and HIV self-management among men who have sex with men: The chain mediating role of social support and self-efficacy.

HIV infection becomes a manageable disease, and self-management is one of the key indicators of achieving optimal health outcomes. Men who have sex with men (MSM) living with HIV face many psychosocial challenges when managing HIV infection, such as sexual minority pressure and HIV-related stigma. Higher perceived HIV-related stigma had been related to low self-management. However, the mechanisms underlying the association between HIV-related stigma and HIV self-management are unclear. Two possible mediators include social support and self-efficacy. This study aimed to examine the relationship between HIV-related stigma and HIV self-management among MSM living with HIV and to explore the single mediating effect of social support and self-efficacy and the chain mediating effect of these two variables on this relationship in China. Convenience sampling was used to recruit participants from the Center for Disease Control (CDC) in Changsha City, Hunan province, China. A total of 459 MSM living with HIV completed questionnaires regarding sociodemographic and disease-related information, HIV-related stigma, social support, self-efficacy, and HIV self-management. Descriptive statistics analysis, one-way ANOVA, independent t-tests, Pearson's bivariate correlation, and multiple regression were conducted using the SPSS v24.0. Process macro in SPSS was used to analyze the single and chain mediating effect among variables. Our findings showed that the indirect and total effect of HIV-related stigma on HIV self-management was significant, while the direct effect was not statistically significant. Social support and self-efficacy mediated the relationship between HIV-related stigma and HIV self-management, respectively. Moreover, the chain mediating model confirmed that the association between HIV-related stigma and HIV self-management was mediated by social support and self-efficacy sequentially. Future interventions focusing on improving HIV self-management among MSM living with HIV should consider a multi-faced approach.

Psychosocial Challenges of School Going Adolescents During Covid-19 Pandemic: Teachers' and Parents' Perspective

Psychosocial Challenges of School Going Adolescents During Covid-19 Pandemic: Teachers' and Parents' Perspective

Psychosocial distress in young adults surviving hematological malignancies: a pilot study

PurposeSurvivors of cancer during young adulthood face multiple psychosocial challenges following treatment. This study explores psychosocial distress and unmet needs among young adult survivors treated of hematological malignancies.MethodsA total of 85 young adults aged between 18 and 39 years at time of diagnosis, were invited to join the survey after the completion of treatment with curative intent. Sociodemographic data and the need for advice were gathered with a self-report questionnaire. A set of standardized questionnaires for quality of life (EORTC QLQ-C30), psychosocial stressors (PHQ-S), fear of progression (PA-F-KF), cancer-related fatigue (EORTC QLQ-FA12), and symptoms of anxiety (GAD-7) or depression (PHQ-9) was employed. Descriptive statistics and multivariate analysis were conducted.ResultsForty-seven young adult cancer survivors responded. A quarter of patients (26%) reported depressive symptoms, 15% suffered from anxiety, 36% from fear of progression, and 21% reported increased psychosocial stressors. They had a lower QoL than the general population and reported poorer outcomes on all single-item and multi-symptom scales. Employment was significantly associated with lower levels of psychosocial distress, anxiety, fatigue, and better QoL.ConclusionYoung adult cancer survivors exhibited a high disposition for psychosocial distress. They reported excessive demands in everyday life and resumption of work. However, a longitudinal study of young adult cancer survivors is needed to confirm the results of this pilot study. In future, psycho-oncological and social support need to become an inherent part of the aftercare of survivors of young adult cancer survivors.

Undergoing radical treatment for prostate cancer and its impact on wellbeing: A qualitative study exploring men's experiences.

Quality of life in prostate cancer survivorship is becoming increasingly important, with mental and social wellbeing recognised as key components. However, limited global evaluation of psychosocial challenges experienced after treatment exists. Therefore, we aimed to explore the lived experiences of men who underwent radical treatment, and its psychosocial impact. This qualitative study was conducted using 19 men who had undergone radical treatment (prostatectomy or radiotherapy) for their cancer. Semi-structured interviews were conducted exploring lived experiences of men after treatment. A Structured thematic analysis of collected data was undertaken, with an inductive co-construction of themes through the lens of the biopsychosocial model. Themes generated were considered within a psychological, social, and physical wellbeing framework. An initial knowledge gap meant mental wellbeing was strongly impacted initially leading to a 'Diagnostic Blow and the Search for Clarity'. Doubt over individuals' future resulted in 'An Uncertain Future' in many men. Once treatment was completed a 'Reflective journey' began, with men considering their outcomes and decisions made. Social wellbeing was also impacted with many identifying the 'Emotional Repercussions' on their relationships and the impact their diagnosis had on their partner and family. Many subsequently sought to increase their support through 'The Social Network and Advocacy', while physical changes led to an increased need for 'Social Planning'. Finally, physical wellbeing was highlighted by a continual acknowledgement of the 'Natural process of ageing' leading to a reluctancy to seek help, whilst simultaneously attempting to improve existing health via 'The Health Kick'. Radical treatments have a considerable impact on mental and social wellbeing of individuals. Anxiety after diagnosis and significant uncertainty over individual futures exist, with physical complications of treatment leading to social repercussions. Future research should aim to identify forms of support to improve quality of life of these men.

Sensor-Based Assessment of Social Isolation and Loneliness in Older Adults: A Survey.

Social isolation (SI) and loneliness are 'invisible enemies'. They affect older people's health and quality of life and have significant impact on aged care resources. While in-person screening tools for SI and loneliness exist, staff shortages and psycho-social challenges fed by stereotypes are significant barriers to their implementation in routine care. Autonomous sensor-based approaches can be used to overcome these challenges by enabling unobtrusive and privacy-preserving assessments of SI and loneliness. This paper presents a comprehensive overview of sensor-based tools to assess social isolation and loneliness through a structured critical review of the relevant literature. The aim of this survey is to identify, categorise, and synthesise studies in which sensing technologies have been used to measure activity and behavioural markers of SI and loneliness in older adults. This survey identified a number of feasibility studies using ambient sensors for measuring SI and loneliness activity markers. Time spent out of home and time spent in different parts of the home were found to show strong associations with SI and loneliness scores derived from standard instruments. This survey found a lack of long-term, in-depth studies in this area with older populations. Specifically, research gaps on the use of wearable and smart phone sensors in this population were identified, including the need for co-design that is important for effective adoption and practical implementation of sensor-based SI and loneliness assessment in older adults.

Psychosocial and bioethical challenges and developments for the future of vascularized composite allotransplantation: A scoping review and viewpoint of recent developments and clinical experiences in the field of vascularized composite allotransplantation.

Vascularized Composite Allotransplantation (VCA) has evolved in recent years, encompassing hand, face, uterus, penile, and lower extremity transplantation. Accordingly, without centralized oversight by United States Organ Procurement and Transplantation Network (OPTN) or European Programs, centers have developed their own practices and procedures that likely vary, and accordingly, present different levels of rigor to the evaluation process, internationally. The importance of psychosocial factors in the selection process and treatment course has been widely recognized, and therefore, several approaches have been developed to standardize and guide care of VCA candidates and recipients. We propose to develop an international multidisciplinary platform for the exchange of expertise that includes clinical, patient, and research perspectives. Patient perspectives would derive from peer education and the assessment of patient-reported outcomes. To establish a foundation for such a platform, future research should review and combine current VCA protocols, to develop the ethical framework for a standardized psychosocial evaluation and follow-up of VCA candidates and recipients. This review presents a comprehensive overview of recent results in the field of VCA, developments in structural aspects of VCA, and provides viewpoints driven from clinical experience.

Creating A Positive Feedback Loop: Supporting Student Mental Health in Ontario’s Christian Schools

This study examined the development of student mental health service provision by independent Christian schools in Ontario, Canada. Key informant interviews led to the development of three major themes—(i) Culture of Caring: A Christian principle in action, (ii) Equifinality: multiple pathways to the same destination, and (iii) Normalizing Counselling: the creation of a positive feedback loop that was divided into five integrated stages. Three counselling models emerged to address students’ psychosocial and emotional challenges. These programs were viewed as an extension of Christian ministry, holistically providing care within the school system not originally structured to meet such needs

‘They said, let’s teach you how you are going to care for the child at home…’: caregivers’ and healthcare worker’s perceptions and experiences of post-discharge preterm care in eastern Uganda

BackgroundComplications of prematurity are the leading cause of neonatal mortality, and the majority of these deaths occur in low and middle-income countries. Research in these settings has focused on improved outcomes for preterm infants in hospital settings, however, research into the continuation of preterm care in the home after discharge from a neonatal unit is limited. This study examines the experiences and perceptions of caregivers of preterm infants during the initial weeks following discharge from a neonatal unit in Uganda, and the views of healthcare workers (HCWs) on the ability of caregivers to cope.MethodsThis qualitative study used multiple data collection approaches, namely focus group discussions (FGDs), in-depth interviews (IDIs), field observations, and case studies to explore the perceptions and experiences of providing care to preterm infants post-discharge from a neonatal unit in eastern Uganda from the perspectives of caregivers and HCWs.ResultsWe recruited 39 participants with a total of 35 separate sessions including 18 IDIs (12 caregivers and 6 HCWs), 3 FGDs (17 caregivers), and 4 case studies (14 separate IDIs over 5 weeks after discharge, three mothers, and one grandmother). IDIs and FGDs took place at the Mbale Regional Referral Hospital or in participants’ homes.Key themes emerged; preparation for continuing care in the home, psychosocial challenges to providing preterm care in the home, barriers to continuing preterm care in the home, and suggestions for improvement of preterm care in the home. Caregivers had good knowledge and awareness about different aspects of preterm care. Following discharge, caregivers struggled to maintain quality care due to loss of continuous support from the neonatal team, feelings of anxiety and isolation, financial issues, and home responsibilities.ConclusionThis study highlights multiple challenges to continuing preterm care in this Ugandan setting. Improved training and education for caregivers, especially in neonatal resuscitation, enhanced and continued support of the caregiver and infant in the home, and increased community involvement following discharge may all be key solutions. These findings are fundamental to improving care in the home for preterm infants in eastern Uganda and similar settings.

A latent class analysis of health behavior changes after cancer diagnosis among Hispanic/Latino cancer survivors.

We aimed to identify subgroups of Hispanic/Latino (H/L) cancer survivors with distinct health behavior patterns and their associated sociodemographic, medical, and psychosocial characteristics. Baseline data were used from a randomized clinical trial evaluating the efficacy of an enhanced patient navigation intervention in H/L cancer survivors. Participants (n = 278) completed the Lifestyle Behavior Scale and validated questionnaires on health-related quality of life (HRQOL), supportive care needs, distress, and satisfaction with cancer care. Latent class analysis was used to determine the latent classes and associated characteristics. Three latent classes emerged: class 1 (survivors who increased health behaviors [e.g., exercising and eating healthy] since diagnosis); class 2 (no changes in health behaviors since diagnosis); and class 3 (a "mixed class," with a higher or lower engagement across various health behaviors since diagnosis). Participants in class 1 were significantly more educated and less likely to be foreign born. Participants in class 2 were significantly older and more likely to have prostate cancer. H/L cancer survivors in class 3 had a significantly lower income, were less educated, and reported greater unmet supportive care needs, more distress, and poorer HRQOL. Survivors who report engaging in health behaviors less frequently since diagnosis may be experiencing psychosocial challenges and health disparities. Hispanic/Latino cancer survivors may benefit from screening for social determinants of health and mental health needs, prompt referral to supportive care services, community resources, and public services, and participating in culturally informed psychosocial interventions to address their unique needs.

Psycho-social challenges faced by caretakers of children and adolescents aged 0–19 years with sickle cell disease admitted in a tertiary hospital in Eastern Uganda

BackgroundFamilies of children and adolescents living with sickle cell disease face several challenges ranging from psycho-social to social-economic challenges. This study aimed to explore psycho-social challenges experienced by caretakers of children and adolescents aged 0–19 years with SCD and the various coping mechanisms. MethodsA mixed-methods cross-sectional study was carried out among caregivers of children with SCD who were admitted to the pediatric wards of the Mbale Regional Referral Hospital from September 2019 to November 2019. A total of 333 participants were interviewed using a pretested questionnaire and 11 in-depth interviews were conducted. ResultsMost participants 285(85.59%) reported that they experienced psychological challenges and almost all the participants in this study 297(89.19%) experienced social challenges during the care of their patients. Only 36(10.81%) reported not experiencing any social challenges. Almost all the participants reported coping with the situation in various ways of which, 296(88.89%) used acceptance, 9(2.7%) still lived in denial, while 9(2.7%) used talking with others and getting counseled to reduce the intensity of the feelings experienced.Three themes were generated from the in-depth interviews; knowledge of the child's health condition; common symptoms and care, the experience of psycho-social challenges, and coping strategies. ConclusionSickle cell disease has affected two sets of people; the people living with the disease and those who are caring for their loved ones. Being conscious of this will help health practitioners to be more empathetic to patients and caregivers when treating people living with sickle cell disease. The biggest proportion of caretakers of children and adolescents 0–19 years experienced psycho-social challenges. The main coping strategy used by the caretakers was acceptance.

Mental health correlates of HIV-related resilience among older gay men living with HIV/AIDS in New York City: The GOLD studies

Introduction: Older adults represent the greatest proportion of people living with HIV/AIDS (PLWHA) in the U.S. and sexual minority men continue to be disproportionally impacted. As PLWHA age, they face multiple mental and psychosocial health challenges that may impact their overall health and well-being. Resilience may act as a buffer against these challenges. Method: Associations between HIV-related resilience and mental health endorsements were examined among older HIV-positive gay men in New York City. Result: Multivariate analyses indicate those with higher levels of HIV-related resilience were more likely to have lower levels of PTSD and substance dependence and were also more likely to feel financially secure. Conclusion: While further research will help better understand the role resilience has on overall health and well-being of older gay PLWHA, utilizing this perspective can yield important insights that can be used to shift toward strengths-based service and programmatic approaches for this population.

Impact of the COVID-19 Pandemic on Individuals With Hearing Loss and Audiology Practice in a Developing Country.

This study aimed to determine the challenges faced by individuals with hearing loss at a time when many nations were attempting to move from the COVID-19 pandemic to endemic. A cross-sectional survey was conducted on Malaysian adults with hearing loss to determine the impact of the COVID-19 crisis on hearing aid management, communication difficulties, psychosocial challenges, and access to audiological services. One hundred forty-six individuals aged 18 years old and above with hearing loss were recruited from hearing health care centers to participate in the survey. Many of the participants (54.2%) reported significant difficulties communicating with people wearing face masks. For hearing aid management, repairing (36.3%) and fine-tuning devices (30.2%) were considered more challenging than obtaining a battery (21.3%). The COVID-19 pandemic had a serious psychosocial impact on a small portion of the individuals surveyed. Remote services were rarely offered by the audiologists, and most participants preferred in-person treatment. However, the majority perceived that creating awareness and training on telehealth was important. Effective management for people with hearing loss needs to consider the challenges faced by them, as the world prepares to live with the coronavirus. Clinical protocols should consider providing a service that is helpful for the clients as well as safe and sustainable in future pandemics.

Defining patient-centered research priorities in pediatric dermatology.

Patient and caregiver perspectives are critical in understanding dermatologic disease impact, presentation, and management in children. The Pediatric Dermatology Research Alliance (PeDRA) Patient Advisory Committee (PtAC), a group of patient representatives and parents of children with cutaneous disease, pursued a multistep, iterative, consensus-building process to identify comprehensive, high-priority research needs. Building on discussions at the 2020 PeDRA Annual Conference, a research prioritization survey was developed and completed by PtAC members. Survey themes were aggregated and workshopped by the PtAC through a series of facilitated calls. Emerging priorities were refined in collaboration with additional PeDRA patient community members at the 2021 PeDRA Annual Conference. Subsequently, a final actionable list was agreed upon. Fourteen PtAC members (86.7% female) representing patients with alopecia areata, atopic dermatitis, vascular birthmarks, congenital melanocytic nevi, ectodermal dysplasias, epidermolysis bullosa, Gorlin syndrome, hidradenitis suppurativa, ichthyosis, pemphigus, psoriasis, Sturge-Weber syndrome, and pachyonychia congenita completed the survey. Following serial PtAC meetings, 60 research needs were identified from five domains: psychosocial challenges, health care navigation/disease management, causes/triggers, treatments to preserve or save life, and treatments to preserve or save quality of life. Many pediatric dermatology research priorities align across affected communities and may drive meaningful, patient-centric initiatives and investigations.

Understanding the impacts of floods on learning quality, school facilities, and educational recovery in Indonesia.

This research is among the first pieces of work to use the comprehensive school safety (CSS) framework to assess the impacts of floods on quality learning and education infrastructure. The CSS framework is employed here to identify the level of disruption to education services following floods in Jakarta, Indonesia, in 2013. The paper poses three key questions, concerning: (i) disruption to children's access to quality education during the flood emergency in 2013 and the early recovery phase; (ii) the impact of the floods on a school's physical infrastructure; and (iii) the effectiveness and level of success of the 2013 flood responses by relevant stakeholders. Combining quantitative and qualitative strategies, the paper examines the experiences of 100 schools in Jakarta. The findings suggest that the CSS framework offers a more nuanced approach to assessing post-disaster education needs. Moreover, it is also relevant for examining the relationship between the COVID-19 pandemic and relative losses in the education sector.

Caregiver Experiences in Pediatric Hospitalizations: Challenges and Opportunities for Improvement.

There are limited qualitative data describing general pediatric hospitalizations through the caregivers' lens, and most focus on one particular challenge or time during the hospitalization. This qualitative study aimed to address a gap in the description of the breadth and depth of personal challenges caregivers may face during the entire hospitalization, irrespective of severity of patient illness or diagnosis, and explored caregiver-suggested interventions. Caregivers of pediatric patients on the hospitalist service at a Pacific Northwest children's hospital were interviewed to explore their hospitalization experience and solicit feedback for potential interventions. Content was coded iteratively using a framework analysis until thematic saturation was met. Findings were triangulated through 2 focus groups, 1 with parent advisors and the other with hospital physicians and nurses. Among 14 caregivers (7 each of readmitted and newly admitted patients) and focus group participants, emergent domains on difficulties faced with their child's hospitalization were anchored on physiologic (sleep, personal hygiene, and food), psychosocial (feelings of isolation, mental stress), and communication challenges (information flow between families and the medical teams). Caregivers recognized that addressing physiologic and psychosocial needs better enabled them to advocate for their child and suggested interventions to ameliorate hospital challenges. Addressing physiologic and psychosocial needs may reduce barriers to caregivers optimally caring and advocating for their child. Downstream consequences of unaddressed caregiver challenges should be explored in relation to participation in hospital care and confidence in shared decision-making, both vital components for optimization of family-centered care.

Reclaiming the golden calf: Ritual design as creative genre

This presentation summarises how I am progressing an experimental genre of creative writing – ritual design. My project draws upon a surprisingly strong reaction I had to reading the story of the Golden Calf in Exodus 32. I am creatively engaging and changing this story. In the traditional version, while Moses receives stone tablets with God’s commandments, the Israelites, encamped at the base of Mount Sinai, celebrate around a golden calf. God is furious and plans to destroy the entire community, but Moses intercedes. Moses then passes along God’s order to the priestly tribe, the Levites: Take your swords and kill your family and neighbours who celebrated around the calf. The Levites obey and massacre about three thousand people. My project deconstructs and re-envisions this myth, as I believe this is one of the worst stories ever told, a story about slaughtering family and neighbours for heterodox expressions of religiosity. My thesis creatively engages three frameworks – amythia, death anxiety and ritual – while pursuing this driving question: How might re-envisioning the golden calf story be conceived and designed as (1) a ritualised symbolic immortality project that (2) redresses amythia and (3) regulates death anxiety? Considered together, amythia and death anxiety may foster anxiety and related psycho-social challenges, while creative symbolic immortality projects and ritualisation may mitigate these challenges. Speculatively, re-envisioning myth engages these regulatory factors; rituals of creation and rituals of engagement may help to regulate death anxiety, while the re-envisioning effort may serve as a symbolic immortality project. My methodology applies ritual design as a genre of creative writing that encourages readers to reconsider and personalise their own received mythologies and rituals. The creative component of my thesis portrays a community of priests who are changing the golden calf story and leveraging the above frameworks to inform their religious practice.