Functional recovery in older adults with schizophrenia: A national interRAI study.

BACKGROUND: The concept of recovery for people with schizophrenia (PwS) is still a matter of debate. Growing numbers of PwS living to older age calls for examination of their disease trajectories with a focus on recovery. AIM: To compare two groups of PwS (good wellbeing; poor wellbeing) on several psychosocial variables associated with social wellbeing to identify interventions that support functional recovery. METHOD: Data was drawn from participants from across New Zealand (NZ), who had received a formal diagnosis of Schizophrenia; were living independently in the community, and who had undergone their first International Resident Assessment Instrument (interRAI) assessment from 2012 to 2022. We compared two groups of PwS (good social wellbeing; poor social wellbeing) examining associations with demographic and psychosocial variables. RESULTS: We compared interRAI assessments for: 'poor psychosocial wellbeing' (n = 1,378; 67%; 56% female; 70.5% 65 years and over; 36.1% never married); and 'good psychosocial wellbeing' (n = 693; 33%; 61.1% female; 78.1% 65 years and over; 29.8% never married; n = 549 did not have sufficient social wellbeing data to be included). We found significant associations between social wellbeing and depression, disruptive behaviour, decision making, self-expression, understanding verbal information, activity level, self-reported health and medication adherence. Logistical regression showed depression (ß = .84, p < .001, Wald = 51.01, Exp(B) = 2.31) and mild disruptive behaviour (ß = .63, p = .002, Wald = 9.26, Exp(B) = 0.53) were the only predictors of poor social wellbeing. Those who reported some degree of depressive symptoms were 2.31 (CI [1.84, 2.91]) more likely to be in the poor social wellbeing group. CONCLUSIONS: A significant minority (33.5%) of older PwS enjoy positive social wellbeing. Several psychosocial variables are associated with wellbeing. By addressing the comorbidity of depressive symptoms, we may be able to improve wellbeing for older PwS.

Sexual Assault in Older-Age Adults: Criminal Justice Response in New Zealand.

There is growing recognition that older persons, both male and female, may experience sexual assault. One clearly identified gap in the body of scientific literature is examination of the criminal justice response for older adults who have been sexually assaulted. This retrospective age-group comparative data analysis examines publicly available population and police statistics for 2018 to describe rates (per 100,000) of reported sexual assault across adult age categories (young adult, n = 748; adult, n = 1,478; middle age, n = 290; older adult, n = 58) and compare (using Chi-square bivariate analysis) the criminal justice response to sexual assault for these adult age categories in New Zealand (NZ). Sexual assault was perpetrated against victims across all age and sex groups examined. The rate of reported sexual assault against older adults was significantly lower after the age of 65 years (7.90 per 100,000) compared to younger adults aged 20-64 years (87.57 per 100,000). Across age categories no difference was found in the proportion of cases proceeded to court action. This study raises awareness of the topic of sexual assault perpetrated against older persons and shows that a substantial number of older adults experience sexual assault in cases that do not result in court action. It points to the need for policy-makers to consider the reporting of sexual assaults against older persons to justice services.

Mentoring: A Traditional Cook Island Approach to Support Men.

The present study examines a unique Cook Island approach to the rehabilitation and support of men, particularly those who have been convicted of criminal offending or who are experiencing other mental health or interpersonal difficulties. The culturally appropriate method of enabling change is offered via a community-based 24-hr mentoring system to support men. Run by men, the program is based on traditional Pacific ways of male mentoring in which one man helps another. This study examines the male mentoring program via qualitative analyses of semi-structured interviews. Seven men who had experienced mentoring and six mentors who deliver the program describe the mentoring system and their experiences. The study identifies several perceived benefits or themes in relation to the program. The unique Cook Islands' male mentoring program is viewed as beneficial in that it allows males to be open and supported to make change to be re-absorbed into the community, have healthy functioning, and reduce re-offending via the ongoing supportive care.

Impact, Ramifications and Taking Back Control: A Qualitative Study of Male Survivors of Childhood Sexual Abuse.

There is increasing recognition of the occurrence and frequency of male childhood sexual abuse (MCSA). Quantitative and qualitative research has demonstrated a number of adverse outcomes associated with MCSA in terms of mental health, physical health and difficulties in behavioural, social or interrelationship functioning. The present study gives voice to male survivors of childhood sexual abuse by exploring themes around the impact of MCSA over the course of their life. Interpretative phenomenological analysis (IPA) of semi-structured interviews with nine male survivors of childhood sexual abuse identified a single overarching theme of control and six related superordinate themes of: (i) responsibility, blame and shame; (ii) development of knowledge about sex and abuse; (iii) avoidance of coping with abuse; (iv) effects on relationships as adults; (v) disclosure of abuse to others; and (vi) gaining a sense of meaning of the abuse. The findings showed that being sexually abused defines and controls a person's life, and that despite the difficulties experienced by victims to move past the abuse, some experienced a degree of personal growth. The findings illustrate the way in which individuals can create meaning around their abuse experiences and take back control.

Does Gender Affect Judges' Perceptions of Sexual Assault Cases?

There is growing recognition that females engage in harmful sexual behaviour that is similar in severity and type to males. Existing research, however, suggests that there is a bias towards leniency in judicial systems for female sexual offenders (FSOs) in comparison to male sexual offenders (MSOs). Specifically, FSOs receive shorter sentences than do MSOs and are less likely to be sentenced to prison. The majority of research examining disparity in sentence outcomes for FSOs have been analysed through a quantitative lens. Qualitative methodology is also needed to understand any subjective differences in the way that judges perceive case-relevant factors and whether these perceptions differ as a function of the offender's gender. The present study is a qualitative study that examined judges' perceptions and descriptions of FSO compared to MSO in 10 matched cases of sexual offending. The study found that although there were many similarities in how judges perceived FSO compared to MSO, there were also unique differences that could explain more lenient sentences for FSOs (i.e. the vulnerability, poor mental health and adverse backgrounds of FSOs). Other unique differences found were that judges' perception of FSOs behaviour was described as depraved and cruel, whereas MSOs similar behaviour was not described in such an emotive way. The present study provides additional insight into the reasons for a bias towards leniency for FSOs. In particular, it points towards judicial focus on particular personal circumstances that are seen as relevant in sentencing FSOs but not for MSOs.

Spirituality: A Key Component of the Salvation Army's Bridge Programme Model of Treatment in Aotearoa New Zealand.

Spirituality is vital to The Salvation Army's Bridge model of treatment for alcohol and drug addiction. Spirituality is expressed through Recovery Church, prayer, spirituality lifters, the 12-step programme, and focuses on meaning and purpose. We recruited participants from several regional centers throughout Aotearoa New Zealand and evaluated spirituality using the WHOQol-SRPB and open-ended questions. Most participants held broad understandings of spirituality, only a minority equating it with religion. Participants who completed the Programme had statistically significant increases in spiritual wellbeing at end-of-treatment. These increases were maintained at a 3-month follow-up. Increases in spiritual wellbeing were associated with decreases in severity of alcohol and drug use.

Seeking of help and support after experiencing sexual harm: considerations for cisgender women, cisgender men and gender-diverse people.

AIMS: This study examines the help-seeking behaviours of cisgender women, cisgender men and gender-diverse university students who have experienced sexual harm. METHODS: We examine an existing data set from a cross-sectional survey of experiences of sexual harm among university students. Bivariate analyses were used to analyse the type of sexual harm experienced and subsequent help-seeking behaviours. RESULTS: Although more cisgender women reported experiencing sexual harm, data from this survey demonstrates cisgender men and gender-diverse persons also report experiencing sexual harm. Of those who reported having experienced sexual harm, only a small proportion (27%) reported having told someone about their experience. People who told, most often told family or friends. Additionally, a small proportion of cisgender women told specialised sexual violence services or other services. Cisgender men were less likely to tell someone about their experience compared to cisgender women. CONCLUSIONS: Sexual harm affects students of all genders on campus but there may be differential help-seeking behaviours depending on gender. Cisgender men and gender-diverse persons may be less likely to reach out to formal service providers. Support services need to consider how to accommodate the support needs of all survivors, including cisgender men and gender-diverse persons.

The use and impact of repeated questions in diagnostic child abuse assessment interviews.

There is limited research regarding the use of repeated questions and the subsequent response from children in real-world forensic contexts. We analysed 71 transcripts of diagnostic assessments in which 3- to 6-year-olds were assessed for suspected abuse experiences. On average, 6% of interviewer questions were repeated, and 47% of the repeated questions were abuse-related. The majority (65%) of the repeated questions were directive, but 33% of the repeated questions contained implicit assumptions. Implicit assumption questions were more likely to be abuse-related. Interviewers repeated questions when the child failed to answer due to playing (31%), for no apparent reason (26%) or for clarification purposes (29%). Children most commonly responded to repeat questions by providing new information (64%), not responding at all (19%) or repeating information (12%). We recommend that interviewers avoid the use of suggestive and repeated questions that contain implicit assumptions in relation to assessment of suspected child abuse.

"It's Not a Great Boulder, It's Just a Piece of Baggage": Older Women's Reflections on Healing from Childhood Sexual Abuse.

In this study, we explored older women's reflections on processes of healing related to childhood sexual abuse (CSA). We aimed to answer questions about how childhood trauma was integrated into the life story and to identify factors or coping strategies that aided, or hindered, healing. Participants within this study included 12 women who were aged 60 or older and had reported CSA as adults at the beginning of the research project, 25 years prior. Qualitative interviews were conducted exploring women's reflections on the place of CSA in their lives over time and factors the participants thought were helpful or unhelpful in being able to come to terms with the abuse. Data were analyzed using thematic analysis, which resulted in three themes related to processes of healing. The themes identified were need for resolution, thinking about it differently, and developing agency over disclosure. The findings show that some form of resolution was needed for the women to recover and move on from their experiences of CSA. The two key strategies used to reach this resolution were reframing their experience or drawing upon positive life philosophies. Decisions around disclosure were also an important part of the healing process, with the women developing an agency over if, and how, they talked to people about their experience. Those women who were not able to make sense of their experience continued to be influenced by the negative feelings and memories associated with the experience. Our findings have implications for health professionals working with those who have experienced trauma. They demonstrate that there are a number of ways that people heal from trauma and find personal resolution across their lifespan.

App-based mindfulness meditation for psychological distress and adjustment to college in incoming university students: a pragmatic, randomised, waitlist-controlled trial.

Objective and Design: In a pragmatic, randomised, waitlist-controlled trial we tracked 250 first-year university students who were randomly assigned to 3 months of a mindfulness meditation app (Headspace) to use at their discretion in either semester 1 (intervention, n = 124) or semester 2 (waitlist, n = 126). Main Outcome Measures: Students reported their distress, college adjustment, resilience, self-efficacy, and mindfulness, at 3 timepoints: the beginning of semester 1, the beginning of semester 2, and the end of the academic year. With participants' permission, the university provided academic achievement data and Headspace provided app use data. Results: Evidence for improvements in distress at the beginning of semester 2 was weak (intervention vs. waitlist) and app use was low (M = 7.91, SD = 15.16 sessions). Nevertheless, intervention participants who used the app more frequently reported improvements in psychological distress (-5 points, R2 change = .12) and college adjustment (+10 points, R2 change = .09) when compared to non-users. App initiation and persistence beyond the first week was higher when the app was provided in semester 1 than semester 2 (66.1% vs. 44.4%; 46.0% vs. 32.5%). Conclusion: Headspace use was associated with small improvements in distress and college adjustment in first-year university students. Intervening at the beginning of the academic year may encourage uptake.

Singapore Sling: F1 Race Team Cognitive Function and Mood Responses During the Singapore Grand Prix.

O'Neill, BV, Davies, KM, and Morris-Patterson, TE. Singapore sling: F1 race team cognitive function and mood responses during the Singapore grand prix. J Strength Cond Res 34(12): 3587-3592, 2020-The current investigation measured cognitive performance and subjective ratings of mood and sleep in Formula 1 (F1) race team members during the 2013 Singapore Grand Prix. Two weeks before the Singapore Grand Prix, subjects (n = 16; mean age 33.5 years, range 22-48 years) underwent baseline cognitive assessments and a questionnaire on mood and sleep quality/duration. These assessments were repeated on the race weekend before practice (S1) and after qualifying (S2). A significant increase in simple reaction time (SRT), i.e., slowing of total response time was observed from baseline to S1 (33.69 ± 6.52 ms; p < 0.001) and from baseline to S2 (34.63 ± 8.19 ms; p = 0.002). Mood-related effects were observed with subjective stress levels increased from baseline to S1 (18.06 ± 6.18; p = 0.032) and a decrease in how refreshed the race team members felt between S1 and S2 (18.56 ± 6.14; p = 0.029). In addition, a negative association between change in SRT and change in quality of sleep (R = 0.47; p = 0.016) as well as negative association in how refreshed individuals reported feeling and SRT between S1 and S2 (R = 0.37; p = 0.017). The findings suggest that the demands presented by an F1 race environment have significant effects on cognitive function and mood; however, the exact cause of any decrements would most likely be a combination and interaction of multiple factors. Future research should endeavor to adopt a holistic approach and investigate physiological and cognitive endpoints to fully explore the demands of this challenging motor sport.

Listening to the Therapeutic Needs of Male Survivors of Childhood Sexual Abuse.

Childhood sexual abuse of males is not uncommon with estimated prevalence rates across countries and different studies indicating that 8% of boys experience sexual abuse before age 18. A number of adverse outcomes are recognized in terms of mental health, behavioral, and relational difficulties. However, research also indicates that there is potential for healing. The present study explores the barriers, benefits, and processes involved in engagement in formal therapy for adult survivors of CSA from the male survivor's point of view. Nine men spoke of their treatment experiences in response to semistructured interviews. Participants were all members of a group for male survivors of sexual abuse. Seven participants reported benefiting from treatment. Interpretative phenomenological analysis (IPA) of the interviews identified three superordinate themes: "motivation to engage in treatment," "developing a connection with treatment providers," and "changing thinking about the abuse." These themes reveal a number of obstacles that are encountered in seeking treatment including stigma, process barriers, and engagement of a skilled and empathic therapist. For the men who were able to take part in therapy despite these barriers, improved quality of life were noted through the two primary mechanisms of relationship and changed thinking. Key changes in thinking included developing an awareness that they were not responsible for the abuse, understanding the effects of abuse, and developing an identity distinct from the experience of abuse. These changes in thinking occurred within the context of a robust therapeutic relationship.

The peril of self-reported adherence in digital interventions: A brief example.

Adherence is an important predictor of intervention outcomes, but not all measures of adherence are created equally. Here, we analyzed whether there was a discrepancy between self-report adherence and objective adherence in a digital mindfulness meditation randomised, controlled trial. A sample of 174 young adult undergraduate university students trialled either an app-based or email-based mindfulness meditation program (or an app-based attention control). Participants' adherence (number of sessions completed) and mental health was self-reported. Objective adherence data were provided by the owners of the digital mindfulness programs. We found evidence of inflated self-reported adherence to the app-based intervention and argue that the inflation was not explained by social desirability biases because participants were aware we would have access to object data and no remuneration was tied to adherence. We also comment on the different conclusions we would have drawn about the effectiveness of the digital interventions on mental health, had we used the self-reported adherence data rather than the objective adherence data. We use this example to suggest that it may be perilous to rely on self-reported measures of adherence when assessing the effectiveness of digital interventions.

Childhood sexual abuse, poly-victimization and internalizing disorders across adulthood and older age: Findings from a 25-year longitudinal study.

BACKGROUND: We aimed to investigate associations between childhood sexual abuse and maltreatment and internalizing disorders (anxiety, depression, PTSD) across adulthood. METHODS: Following a postal survey of 2220 women, a subsample was selected to participate in an interview. The subsample included 276 women reporting childhood sexual abuse and 221 women with no reported history of childhood sexual abuse. Interviews were repeated six and 25 years following the first interview. Internalizing disorders were assessed using ICD-8 and DSM-III criteria. RESULTS: There was a lower probability of having an internalizing disorder at older ages than younger ages for all women, regardless of maltreatment history. Latent class analysis was used to define three classes (no/low maltreatment, sexual abuse, poly-victimisation). Compared with no/low maltreatment, a history of childhood sexual abuse was associated with almost double the risk of an internalizing disorder and a history of poly-victimisation was associated with over four times the risk of an internalizing disorder. Childhood sexual abuse and poly-victimisation remained associated with an elevated risk of a disorder in older age. LIMITATIONS: Findings are limited by attrition (39% participated at Time 3), low prevalence of severe physical abuse, and changes in assessment practice of childhood maltreatment and mental disorder in the past 30 years. CONCLUSIONS: Screening and treatment for internalizing disorders in women with histories of childhood maltreatment remains important in older aged populations.

Interviews with children about their mental health problems: The congruence and validity of information that children report.

To obtain a child's perspective during a mental health assessment, he or she is usually interviewed. Although researchers and clinicians generally agree that it is beneficial to hear a child's account of his or her presenting issues, there is debate about whether children provide reliable or valid clinical information during these interviews. Here, we examined whether children provide clinically and diagnostically relevant information in a clinical setting. In all, 31 children aged 5-12-years undergoing mental health assessments were asked open-ended questions about their presenting problems during a semi-structured interview. We coded the information that children reported to determine whether it was clinically relevant and could be used to diagnose their problems and to formulate and plan treatment. We also coded children's information to determine whether it was congruent with the children's presenting problems and their eventual clinical diagnoses. Most of the information that children reported was clinically relevant and included information about behaviour, affect, temporal details, thoughts, people, the environment, and the child's physical experiences. The information that children reported was also clinically valid; it was congruent with the problems that were discussed (84%) and also with the eventual diagnosis that the child received after a complete assessment (74%). We conclude that children can contribute relevant, clinically useful, valid information during clinical psychological assessments.

Influence of law changes affecting synthetic cannabinoid availability and frequency of hospital presentations: 4-year national survey.

AIMS: We previously reported that passage of the 2013 Psychoactive Substances Act (PSA), which limited retail availability of synthetic cannabinoids (SCs), was followed by reduced numbers of presentations to one psychiatric emergency service. This analysis examined national trends in hospital presentations associated with use of SCs, and how these changed after passage of laws in 2011, 2013 and 2014, that altered SC availability. METHODS: Analysis of 2011-2015 Ministry of Health dataset of patients presenting to hospital associated with use of SCs. The relationship between changes in hospital presentations and the 3 legislative changes was evaluated using time series models. RESULTS: Monthly hospital presentations peaked in mid-2011, 2013 and 2014. Steep declines in numbers of presentations occurred after law changes between August and September 2011 (current SCs removed from sale), July and August 2013 (reduced number of SC retail outlets), and May and June 2014 (all SCs banned). The 2013 reduction in supply was associated with mean monthly presentations decreasing by 10.6 (95% CI 1.5, 19.7; p=0.023). Patients were predominantly young males, and presented with a range of emotional, psychotic and behavioural symptoms. CONCLUSIONS: Law changes that reduced SC availability were associated with reduced harms (hospitalisation) associated with use of SCs.

Drawing helps children to talk about their presenting problems during a mental health assessment.

When children require mental health services, clinicians need to conduct assessments that are developmentally sensitive and that include the child's point of view. Drawing is a popular tool that is commonly used in clinical settings. Research on drawing in experimental settings has confirmed that the opportunity to draw while talking increases the amount of verbal information that children report during an interview. The present research examined whether drawing also facilitates children's self reports during a mental health assessment. A total of 33 5-12-year-old children were asked either to draw and tell about their presenting problem or to tell only. Children who drew and told provided twice as much verbal information as children who told only. Further, interviewers in the draw and tell condition used a greater number of minimal responses than did interviewers in the tell only condition. These data have important implications for clinical practice.

Thoughts of suicide and stage of recovery in patients with schizophrenia in community mental health care.

OBJECTIVE: Suicidality among patients with schizophrenia remains a major concern. The consumer-oriented concept of recovery has been recognised as important in recent years. We aimed to assess whether there was any relationship between stages of recovery and suicidality among people with schizophrenia in community care. METHOD: In a community mental health service, 85 patients with schizophrenia consented to an interview during which their stages of recovery were assessed using the Stages of Recovery Instrument. They were asked about suicidality and screened for depression using the Revised Clinical Interview Schedule. Insight was assessed via the Insight and Treatment Attitudes Questionnaire. Data analysis involved logistic regression. RESULTS: In the past year 14% of the patients reported having wanted to die and 13% had considered suicide. Scores indicating the highest stage of recovery were associated with lower odds of suicidal thoughts. In contrast, suicidality was not significantly associated with depression or stage of insight. CONCLUSION: The link found between suicidality and stages of recovery has practical implications for suicide prevention among those with schizophrenia in community care. Approaches that facilitate the recovery process may reduce suicidal thoughts in this population.

Compulsory community treatment and patients' perception of recovery in schizophrenia.

OBJECTIVE: This study examined whether patients' perception of recovery differed for those receiving treatment under a compulsory treatment order (CTO) compared to those who were not. METHOD: A total of 86 participants with schizophrenia/schizo-affective disorder were interviewed about their views on recovery, and their clinical files were examined to ascertain if they were under a CTO at time of interview. RESULTS: No association between being under a CTO and recovery beliefs was found. Irrespective of whether patients were under a CTO or not, the majority of participants (82%) reported that they thought recovery is possible and half of the participants (51%) reported that they were in recovery. CONCLUSION: The present study found no evidence that being under a CTO was related to additional pessimistic views about recovery or being recovered. Participants under a CTO were no more or less likely to report that recovery was possible, and that they were recovered, as participants who were not under a CTO.