Evaluation of Youth Mental Health First Aid USA: A program to assist young people in psychological distress.

Youth Mental Health First Aid USA (YMHFA) is a manualized training program designed to educate members of the public on common emotional problems and psychological disorders among youth and to provide trainees with tools anyone can use to assist young people in psychological distress. The present study used a pre versus post design to assess the ability of social service employees to generate appropriate strategies to use in hypothetical situations featuring a young person in distress, before versus after participation in the 8-hr YMHFA training. Trainee responses demonstrated significant overall improvement (M = 1.32, SD = 0.80 pretraining vs. M = 1.87, SD = 1.1 posttraining, t = 6.6, p < .001) by including four of the five central YMHFA strategies significantly more often after training. Increased confidence in, likelihood of, and comfort with helping a young person in emotional distress or crisis were also reported posttraining compared to pretraining (all p ≤ .001). Results suggest that individuals participating in YMHFA training are better informed regarding when to assess for risk of suicide, listen nonjudgmentally, encourage appropriate professional help, and encourage self-help strategies with young people in psychological distress. (PsycINFO Database Record

Veterans with PTSD report more weight loss barriers than Veterans with no mental health disorders.

OBJECTIVE: This study characterized and compared Veterans of the United States Armed Forces with posttraumatic stress disorder (PTSD) to Veterans with no mental health disorders on self-reported measures of factors that influence success in weight management programs. METHOD: We examined the relation of PTSD diagnosis with weight loss plan, reasons for overweight/obesity and barriers to dieting and physical exercise among 171,884 Veterans. Statistically significant variables in chi-square tests (P<.05) with at least a small effect size were then compared via multivariate logistic regression analyses. RESULTS: Both groups reported high ratings of importance and confidence regarding changing weight loss behaviors and were preparing or actively engaging in efforts to manage their weight. Compared to Veterans without mental health disorders, more Veterans with PTSD endorsed 27 of the 28 barriers to changing eating and physical habits. CONCLUSIONS: The results of this study help to explain the lower rates of success of Veterans with PTSD in weight loss programs. Results suggest that a comprehensive, integrated approach to promoting weight loss in Veterans with PTSD is needed.

The relationship between stigma sentiments and self-identity of individuals with schizophrenia.

OBJECTIVE: Stigma sentiments are the attitudes held toward a culturally devalued label or group. The present study measures schizophrenia stigma sentiments and self-identity to assess self-stigma experienced by people with schizophrenia. METHOD: Ninety individuals with schizophrenia and 23 controls with no history of psychosis rated the evaluation, potency, and activity of "A person with schizophrenia or schizoaffective disorder," (stigma sentiments) and of "Myself as I really am" (self-identity). t tests, correlations, and regression analysis were used to (a) test relationships among stigma sentiments and self-identity in the groups separately; (b) test a model for predicting self-identity in the schizophrenia group, using stigma sentiments, current symptoms, and current functioning; and (c) compare the participant groups' stigma sentiments and self-identities. RESULTS: The evaluation category of self-identity and of stigma sentiment were correlated in the schizophrenia group, r(88) = .44, p < .001, but not in the control group. Current symptoms and the evaluation category of stigma sentiments were significant predictors of the evaluation category of self-identity in the schizophrenia group. The evaluation and potency stigma sentiments reported by the 2 groups did not differ; the control group rated itself more favorably on evaluation and potency than did the schizophrenia group. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Self-evaluation of individuals with schizophrenia was less favorable than self-evaluation of individuals with no psychosis history, and evaluation attitudes held by individuals with schizophrenia regarding the schizophrenia label were associated with their self-identity. Results suggest preliminary utility of this simple measure in identifying self-stigma experienced by individuals with schizophrenia.

Trauma exposure and PTSD in women with schizophrenia and coexisting substance use disorders: comparisons to women with severe depression and substance use disorders.

The present study compared rates of trauma exposure and PTSD among three groups of women at high trauma risk: those with substance use disorders (SUD) and schizophrenia (n=42), those with SUD and severe, nonpsychotic depression (n=38), and those with SUD and no other DSM-IV Axis I condition (n=37). We hypothesized that exposure to traumatic stressors and current diagnosis of PTSD would be more common in women with schizophrenia and SUD, when compared to the other two groups. Results indicate that women with schizophrenia and SUD had a more extensive trauma history than women with SUD only, and were also more likely to have PTSD. Women with schizophrenia had a fourfold greater likelihood of meeting criteria for current PTSD than were women with severe, nonpsychotic depression when potential confounds of age, race, education, severity of trauma history, and childhood trauma exposure were controlled. These results lend support to the possibility that women with psychosis have an elevated vulnerability to PTSD symptomology when exposed to life stressors that is distinct from the vulnerability associated with coexisting nonpsychotic SMI. The psychological sequelae of trauma are substantial and should be addressed in women seeking treatment for schizophrenia and problematic substance use.

Mental health service utilization by Iraq and Afghanistan veterans after entry into PTSD specialty treatment.

OBJECTIVE: Use of care by Iraq and Afghanistan veterans was examined after entry into a U.S. Department of Veterans Affairs (VA) specialty outpatient program for treatment of posttraumatic stress disorder (PTSD). Those who had received mental health care before entry (continuing patients) were compared with those who had not (new patients). METHODS: Regression analyses compared veterans' retention in PTSD programs in the 180 days after program entry for new patients (N=172) and continuing patients (N=422). Two retention measures, total visits and completion of nine or more visits, were developed from VA administrative data. RESULTS: New patients completed fewer PTSD visits than did continuing patients (5.2±9.5 versus 8.3±14.3; incidence risk ratio=.91, 95% confidence interval [CI]=.85-.97) and were also less likely to complete nine or more visits (OR=.81, CI=.68-.97). CONCLUSIONS: Contact with providers before entering PTSD specialty care may facilitate veterans' treatment engagement, suggesting the value of repeated attempts at engaging such veterans in treatment.

A model of internalized stigma and its effects on people with mental illness.

OBJECTIVES: The investigators aimed to examine the prevalence of internalized stigma among individuals with serious mental illness and to construct and test a hypothesized model of the interrelationships among internalized stigma, self-concept, and psychiatric symptoms. METHODS: One hundred individuals, most of whom were African American and had a diagnosis of serious mental illness, were receiving mental health services from one of three community outpatient mental health programs or one Veterans Affairsmedical center. They completed an interview that included measures of internalized stigma, psychiatric symptoms, self-esteem, selfefficacy, and recovery orientation. Structural equation modeling (SEM) was used to examine the interrelationships among these variables. RESULTS: Thirty-five percent of participants reported moderate to severe levels of internalized stigma, which was not significantly associated with any demographic variable or diagnosis. However, greater internalized stigma was associated with lower levels of self-esteem, self-efficacy, and recovery orientation, as well as with more severe psychiatric symptoms. The SEM produced a nonsignificant chi square statistic and other fit indices indicative of a good model fit (goodness-of-fit index=.96, root mean square error of approximation=.011). CONCLUSIONS: Results suggest that internalized stigma was prevalent and problematic among individuals with serious mental illness. There may be multiple pathways through which stigma and discrimination lead to negative outcomes, suggesting that interventions to reduce internalized stigma need to target multiple points along these pathways in order to be effective.

Beliefs about antipsychotic versus hypoglycemic medications among individuals with serious mental illness and type 2 diabetes.

BACKGROUND: This study compared the beliefs held by individuals with coexisting serious mental illness and type 2 diabetes regarding the necessity and risks of taking antipsychotic versus hypoglycemic medications. We also investigated whether nonadherent patients differed from adherent patients in their beliefs about medications. METHODS: Forty-four individuals with type 2 diabetes and serious mental illness who were prescribed hypoglycemic and antipsychotic medications completed a cross-sectional assessment of medication beliefs and adherence for both medication types. RESULTS: Patients perceived a greater need for hypoglycemic versus antipsychotic medications; however, their beliefs were not associated with nonadherence to either medication type. CONCLUSION: These results suggest that individuals with coexisting serious mental illness and type 2 diabetes have stronger convictions regarding the necessity of their diabetes medication for maintaining their health.

Predicting social functioning in schizotypy: an investigation of the relative contributions of theory of mind and mood.

Theory of mind (ToM) is an aspect of social cognition that refers to the ability to make inferences about the thoughts, feelings, and intentions of other people. It is believed to be related to social functioning. Previous investigations of ToM in schizotypy have yielded mixed results. Using a correlational approach, the present study explored the relationship between schizotypal traits, ToM, neurocognition, depressed mood, and social functioning in a sample of 50 undergraduate students. Schizotypy was related to poor social functioning. Contrary to predictions, schizotypal traits were not associated with impaired ToM. In fact, schizotypal traits were associated with enhanced performance on a ToM task that involved detection of ironic statements. However, strong relationships emerged among schizotypy, depressed mood, and social functioning, highlighting the need to also examine depression when assessing the relations between elevated schizotypy and poor social functioning.

Reality monitoring and its association with social functioning in schizophrenia.

Reality monitoring, or the ability to discriminate internal from external information present in short-term memory, is relevant in the study of schizophrenia. Previous research has linked monitoring impairments with psychotic symptoms and certain forms of communication disturbance. The focus of the present study was to test the hypothesis that there would be specific relationships between reality monitoring in patients with schizophrenia and current and pre-morbid social functioning, beyond the effects of general verbal ability. Fifty outpatients with schizophrenia or schizoaffective disorder were assessed for internal/external reality monitoring deficits, general verbal intelligence, and both current and pre-morbid social functioning. Associations between these variables were assessed. Exploratory analyses also were conducted to determine whether specific types of reality monitoring errors were related to social functioning. Results showed that (a) overall accuracy in reality monitoring was related to pre-morbid social functioning beyond the effects of verbal ability, (b) sensitivity to old versus new information in reality monitoring was related to current social functioning, and (c) a say-report-think reality monitoring error was significantly associated with pre-morbid social functioning. The results support the hypothesis of an association between reality monitoring sensitivity and social functioning.

Anxiety interacts with expressed emotion criticism in the prediction of psychotic symptom exacerbation.

Psychotic symptoms are exacerbated by social stressors in schizophrenia and schizoaffective disorder patients as a group. More specifically, critical attitudes toward patients on the part of family members and others have been associated with a higher risk of relapse in the patients. Some patients appear to be especially vulnerable in this regard. One variable that could affect the degree of sensitivity to a social stressor such as criticism is the individual's level of anxiety. The present longitudinal study assessed 27 relatively stable outpatients with schizophrenia or schizoaffective disorder and the single "most influential other" (MIO) person for each patient. As hypothesized, (1) patients with high critical MIOs showed increases in psychotic symptoms over time, compared with patients with low critical MIOs; (2) patients high in anxiety at the baseline assessment showed increases in psychotic symptoms at follow-up, compared with patients low in anxiety, and (3) patients with high levels of anxiety at baseline and high critical MIOs showed the greatest exacerbation of psychotic symptoms over time. Objectively measured levels of criticism were more predictive than patient-rated levels of criticism.

Attributional style in delusional patients: a comparison of remitted paranoid, remitted nonparanoid, and current paranoid patients with nonpsychiatric controls.

Many studies have found that people experiencing persecutory delusions have a marked tendency to use external-personal attributions when establishing the causes of negative events. Although nonclinical populations also tend to attribute negative events to external causes, those causes are typically believed to be universal in nature, rather than personal. The central goal of the present study was to investigate whether individuals with remitted persecutory delusions would display this external-personal bias regarding negative events, in comparison to remitted patients whose delusions were not paranoid in nature and to nonpsychiatric controls. Results indicate that currently paranoid patients were significantly more likely than all other groups, including the remitted paranoid group, to use external-personal attributions in negative events. Interestingly, all patient groups also were found to be significantly more likely than the controls to use internal-personal and internal-universal attributions when explaining negative events.

Life events and high-trait reactivity together predict psychotic symptom increases in schizophrenia.

Psychotic symptoms are exacerbated by stressful life events in schizophrenia patients as a group. Some individuals appear to be more vulnerable than others in this regard. This study tested whether schizophrenia patients are highly emotionally reactive compared with controls and whether the level of trait emotional reactivity in patients influences the degree to which they respond to life stressors with exacerbations of psychosis. Schizophrenic outpatients and nonpsychiatric controls were assessed for levels of trait emotional reactivity, arousability, and trait anxiety. Severity of symptoms was also rated in the patients. Patients were then followed up 9 months later, assessed for independent stressful life events occurring during the month before the follow-up session, and reassessed for symptom levels. The patients scored higher than the control subjects on all 3 measures of reactivity at the initial assessment. At follow-up, the occurrence of potentially stressful life events predicted increases in psychotic symptoms in patients, and there was a significant interaction between level of initial trait reactivity and the occurrence of life events in the prediction of these increases. High-trait-reactive patients showed increases in psychotic symptoms in response to life stressors, whereas low-trait-reactive patients did not. These findings support the idea that patients as a group have higher than normal levels of trait reactivity and also that patients with very high levels of trait reactivity are at elevated risk of psychotic relapse under stress. Such patients might benefit particularly from interventions designed to assist them in coping with potentially stressful life events and circumstances.

Schizophrenic patients' perceptions of stress, expressed emotion, and sensitivity to criticism.

This study was designed to get an "insider's view" of expressed emotion (EE) from the perspective of schizophrenic patients. Thirty-two patient and "influential other" pairs participated in the study. Patients' perceptions of EE attitudes in influential others were examined to determine whether they corresponded with actual EE ratings. Patients also rated how "stressed" they felt when interacting with their influential others, and patients' general sensitivity to criticism (STC) was assessed. As predicted, patients' perceptions of critical attitudes were related to actual EE ratings of criticism, although patients' perceptions of emotional overinvolvement (EOI) were not related to EOI ratings. Patients reported feeling more stressed when interacting with high-EE influential others, supporting an "EE as stressor" hypothesis. Finally, patients' STC influenced the level of stress they reported.