A cluster RCT to improve workplace mental health in a policing context: Findings of a mixed-methods implementation evaluation.

BACKGROUND: We conducted a cluster randomized trial of a workplace mental health intervention in an Australian police department. The intervention was co-designed and co-implemented with the police department. Intervention elements included tailored mental health literacy training for all members of participating police stations, and a leadership development and coaching program for station leaders. This study presents the results of a mixed-methods implementation evaluation of the trial. METHODS: Descriptive quantitative analyses characterized the extent of participation in intervention activities, complemented by a qualitative descriptive analysis of transcripts of 60 semistructured interviews with 53 persons and research team field notes. RESULTS: Participation rates in the multicomponent leadership development activities were highly variable, ranging from <10% to approximately 60% across stations. Approximately 50% of leaders and <50% of troops completed the mental health literacy training component of the intervention. Barriers to implementation included rostering challenges, high staff turnover and changes, competing work commitments, staff shortages, limited internal personnel resources to deliver the mental health literacy training, organizational cynicism, confidentiality concerns, and limited communication about the intervention by station command or station champions. Facilitators of participation were also identified, including perceived need for and benefits of the intervention, engagement at various levels, the research team's ability to create buy-in and manage stakeholder relationships, and the use of external, credible leadership development coaches. CONCLUSIONS: Implementation fell far short of expectations. The identified barriers and facilitators should be considered in the design and implementation of similar workplace mental health interventions.

The Vitamins in Psychosis Study: A Randomized, Double-Blind, Placebo-Controlled Trial of the Effects of Vitamins B12, B6, and Folic Acid on Symptoms and Neurocognition in First-Episode Psychosis.

BACKGROUND: Elevated homocysteine is observed in schizophrenia and associated with illness severity. The aim of this study was to determine whether vitamins B12, B6, and folic acid lower homocysteine and improve symptomatology and neurocognition in first-episode psychosis. Whether baseline homocysteine, genetic variation, sex, and diagnosis interact with B-vitamin treatment on outcomes was also examined. METHODS: A randomized, double-blind, placebo-controlled trial was used. A total of 120 patients with first-episode psychosis were randomized to an adjunctive B-vitamin supplement (containing folic acid [5 mg], B12 [0.4 mg], and B6 [50 mg]) or placebo, taken once daily for 12 weeks. Coprimary outcomes were change in total symptomatology (Positive and Negative Syndrome Scale) and composite neurocognition. Secondary outcomes included additional measures of symptoms, neurocognition, functioning, tolerability, and safety. RESULTS: B-vitamin supplementation reduced homocysteine levels (p = .003, effect size = -0.65). B-vitamin supplementation had no significant effects on Positive and Negative Syndrome Scale total (p = .749) or composite neurocognition (p = .785). There were no significant group differences in secondary symptom domains. A significant group difference in the attention/vigilance domain (p = .024, effect size = 0.49) showed that the B-vitamin group remained stable and the placebo group declined in performance. In addition, 14% of the sample had elevated baseline homocysteine levels, which was associated with greater improvements in one measure of attention/vigilance following B-vitamin supplementation. Being female and having affective psychosis was associated with improved neurocognition in select domains following B-vitamin supplementation. Genetic variation did not influence B-vitamin treatment response. CONCLUSIONS: While 12-week B-vitamin supplementation might not improve overall psychopathology and global neurocognition, it may have specific neuroprotective properties in attention/vigilance, particularly in patients with elevated homocysteine levels, patients with affective psychosis, and female patients. Results support a personalized medicine approach to vitamin supplementation in first-episode psychosis.

Depression literacy and help-seeking in Australian police.

OBJECTIVE: To assess depression literacy, help-seeking and help-offering to others in members of the police force in the state of Victoria, Australia. METHODS: All staff in police stations involved in a cluster randomised controlled trial of an integrated workplace mental health intervention were invited to participate. Survey questions covered sociodemographic and employment information, recognition of depression in a vignette, stigma, treatment beliefs, willingness to assist co-workers with mental health problems, help-giving and help-seeking behaviours, and intentions to seek help. Using the baseline dataset associated with the trial, the paper presents a descriptive analysis of mental health literacy and helping behaviours, comparing police station leaders and lower ranks. RESULTS: Respondents were 806 staff, comprising 618 lower-ranked staff and 188 leaders. Almost 84% of respondents were able to correctly label the problem described in the vignette. Among those who had helped someone with a mental health problem, both lower ranks and leaders most commonly reported 'talking to the person' although leaders were more likely to facilitate professional help. Leaders' willingness to assist the person and confidence in doing so was very high, and over 80% of leaders appropriately rated police psychologists, general practitioners, psychologists, talking to a peer and contacting welfare as helpful. However, among both leaders and lower ranks with mental health problems, the proportion of those unlikely to seek professional help was greater than those who were likely to seek it. CONCLUSION: Knowledge about evidence-based interventions for depression was lower in this police sample than surveys in the general population, pointing to the need for education and training to improve mental health literacy. Such education should also aim to overcome barriers to professional help-seeking. Interventions that aim to improve mental health literacy and help-seeking behaviour appear to be suitable targets for better protecting police member mental health.

Examining the association between social cognition and functioning in individuals at ultra-high risk for psychosis.

OBJECTIVE: Social and role functioning are compromised for the majority of individuals at ultra-high risk of psychosis, and it is important to identify factors that contribute to this functional decline. This study aimed to investigate social cognitive abilities, which have previously been linked to functioning in schizophrenia, as potential factors that impact social, role and global functioning in ultra-high risk patients. METHOD: A total of 30 ultra-high risk patients were recruited from an established at-risk clinical service in Melbourne, Australia, and completed a battery of social cognitive, neurocognitive, clinical and functioning measures. We examined the relationships between all four core domains of social cognition (emotion recognition, theory of mind, social perception and attributional style), neurocognitive, clinical and demographic variables with three measures of functioning (the Global Functioning Social and Role scales and the Social and Occupational Functioning Assessment Scale) using correlational and multiple regression analyses. RESULTS: Performance on a visual theory of mind task (visual jokes task) was significantly correlated with both concurrent role ( r = 0.425, p = 0.019) and global functioning ( r = 0.540, p = 0.002). In multivariate analyses, it also accounted for unique variance in global, but not role functioning after adjusting for negative symptoms and stress. Social functioning was not associated with performance on any of the social cognition tasks. CONCLUSION: Among specific social cognitive abilities, only a test of theory of mind was associated with functioning in our ultra-high risk sample. Further longitudinal research is needed to examine the impact of social cognitive deficits on long-term functional outcome in the ultra-high risk group. Identifying social cognitive abilities that significantly impact functioning is important to inform the development of targeted intervention programmes for ultra-high risk individuals.

Adjunctive Taurine in First-Episode Psychosis: A Phase 2, Double-Blind, Randomized, Placebo-Controlled Study.

OBJECTIVE: Taurine is an inhibitory neuromodulatory amino acid in the central nervous system that activates the GABA- and glycine-insensitive chloride channel and inhibits the N-methyl-D-aspartate receptor. It also functions as a neuroprotective agent and has a role in neural development and neurogenesis. The aim of this study was to determine the efficacy of adjunctive taurine in improving symptomatology and cognition among patients with a DSM-IV first-episode psychotic disorder. METHODS: 121 patients with first-episode psychosis, aged 18-25 years, attending early intervention services consented to participate in this randomized, double-blind, placebo-controlled trial conducted from January 2007 to May 2009. Patients taking low-dose antipsychotic medication were randomly assigned to receive once-daily taurine 4 g or placebo for 12 weeks. The coprimary outcomes were change in symptomatology (measured by the Brief Psychiatric Rating Scale [BPRS] total score) and change in cognition (measured by the Measurement and Treatment Research to Improve Cognition in Schizophrenia [MATRICS] Consensus Cognitive Battery composite score) at 12 weeks. Secondary outcomes included tolerability and safety and additional clinical and functioning measures. RESULTS: 86 participants (n = 47 taurine; n = 39 placebo) were included in the final analysis. Taurine significantly improved symptomatology measured by the BPRS total score (95% CI, 1.8-8.5; P = .004) and psychotic subscale (95% CI, 0.1-1.5; P = .026) compared to placebo. Additionally, improvements were observed in the Calgary Depression Scale for Schizophrenia (95% CI, 0.1-3.0; P = .047) and Global Assessment of Functioning (95% CI, 0.3-8.8; P = .04) scores. There was no group difference in composite cognitive score (95% CI, -1.7 to 1.0; P = .582). A significant group difference was found on one safety and tolerability item (psychic item 2, asthenia/lassitude/increased fatigability) of the Udvalg for Kliniske Undersogelser, with the taurine group showing a more favorable outcome (P = .006). CONCLUSIONS: Adjunctive taurine did not improve cognition, but it appears to improve psychopathology in patients with first-episode psychosis. The use of taurine warrants further investigation in larger randomized studies, particularly early in the course of psychosis. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00420823.

Externalized attributional bias in the Ultra High Risk (UHR) for psychosis population.

Specific externalizing attributional biases appear to be common in early psychosis. They may represent trait risk factors for the later development of a psychotic disorder, yet few studies have investigated this in clinical "at risk" populations. We aimed to investigate one particular bias, the Locus of Control of reinforcement (LOC) in a "Ultra High Risk" (UHR) for psychosis group. We recruited UHR individuals from an established at risk clinical service and a community control group. LOC was measured using the Adult Nowicki Strickland Internal External scale (ANSIE). Neuropsychological functioning, social functioning and psychopathology were assessed. We analyzed data from 30 controls and 30 UHR individuals. The UHR sample had a significantly more externalized LOC (control for events perceived to be external to the person) than controls. This difference remained statistically significant after adjusting for covariates (age, gender and IQ). More externalized LOC scores were negatively correlated with social and occupational functioning scores in the control group but not in the UHR group and positively correlated with negative symptoms and paranoid symptoms in the UHR group. These findings have implications for identifying potential psychological vulnerabilities for the development of psychosis and informing treatment approaches within the at risk group.

Social cognition in clinical "at risk" for psychosis and first episode psychosis populations.

BACKGROUND: Social cognitive deficits have been demonstrated in first episode psychosis (FEP) and groups at high risk for developing psychosis but the relative degree of deficit between these groups is unclear. Such knowledge may further our understanding of the importance of these deficits in the development of psychosis. The study aimed to compare the degree of impairment in social cognition in three groups: FEP, those at "ultra high risk" (UHR) for psychosis and healthy controls. METHODS: UHR and FEP patients were recruited from an established youth mental health service in Melbourne. Three domains of social cognition were assessed: ToM (hinting task and interpretation of visual jokes); facial and vocal emotion recognition (Diagnostic Assessment of Non Verbal Accuracy); social perception (Mayer-Salovey-Caruso Emotional Intelligence Test - managing emotions branch). Group differences were analysed using Analysis of Covariance with age, gender and IQ as covariates. RESULTS: Data on 30 UHR, 40 FEP and 30 control participants were analysed. FEP patients performed significantly worse on all social cognition tasks compared to controls. For the UHR group, scores were intermediate between FEP and controls for all tasks, but only significantly different to controls for ToM tasks. Effects sizes were largest for the ToM tasks and the emotion recognition task for both patient groups. There were no significant differences between UHR and FEP patients in performance on any of the tasks. CONCLUSIONS: Social cognition is generally impaired in FEP patients but there are fewer deficits in a UHR group. Longitudinal research in larger samples is needed to investigate whether social cognition deficits, such as ToM are risk factors in UHR groups for subsequent transition to full-threshold psychosis.