Time-dependent association between the economic activity restriction due to health condition and mental illness: Finding from 15-year prospective cohort study

Background and Objectives The Economic Activity Restriction (EAR) due to health conditions is being utilized as a foundational measure for the European indicator Healthy Life Years (HLY). The EAR group is experiencing limitations not only in economic activities but also in overall activities, and it is a population with a high likelihood of transitioning to mental illness due to health condition. However, few studies have investigated the relationship between EAR and mental illness. Therefore, the purpose of this study was to identify the association between EAR due to health conditions and mental illness for those aged 45 and older in South Korea. Methods We obtained data from the 2006–2020 Korean Longitudinal Study of Aging. EAR was assessed using self-reported questionnaires based on the Global Activity Limitation Indicator. mental illness was assessed based on the diagnosis data for participants who had been diagnosed. After excluding missing values, the data of 9,574 participants were analyzed using the chi-square test, log-rank tests, and time-dependent Cox proportional hazard model to evaluate the association between EAR and mental illness. Results Out of the 9,574 participants gathered at baseline, the mental illness rate was 4.8 %. The hazard ratio (HR) of mental illness in those in the “very probable” of EAR was 2.351 times higher (p-value <0.0001) compared with “not at all” of EAR. In model 1 which includes under 64 years, HR of mental illness in “very probable” of EAR was 3.679 times higher (p-value: 0.000) and in “probable” of EAR was 2.535 time higher (p-value: 0.001) compared with “not at all” of EAR. Conclusion If we provide opportunities to participate in community activities or provide the mental health promotion programs for middle-aged population who are experiencing EAR due to health condition... (AU)

Factor structure and reliability of the Greek version of Attitudes Towards Mentally Ill Offenders (ΑΤΜΙΟ) Scale in a general population sample.

Mentally ill offenders constitute a group with a unique set of characteristics since they are doubly stigmatized by both their mental illness and the offence they have committed. The coexistence of these two circumstances significantly heightens negative public attitudes towards these people. The group of mentally ill offenders has been shown to elicit more stigmatic attitudes than offenders without a mental health condition. Nevertheless, research on stigma towards mentally ill offenders is rather limited, while the number of psychometric tools used to measure this stigma is even smaller compared to the number of relevant tools assessing mental illness stigma. The purpose of this study was to explore the attitudes towards mentally ill offenders in a Greek sample in terms of demographic characteristics, and at the same time to assess the psychometric properties of a specialized tool on stigma towards this patient group, namely the Attitudes Towards Mentally Ill Offenders (ΑΤΜΙΟ) scale in Greek. The study included 1031 participants from the general population who completed an online questionnaire on sociodemographic data as well as the ATMIO scale. The scale's structural validity was tested on the basis of the exploratory factor analysis after Quartimax rotation, and the internal relevance of its factors recorded a Cronbach's alpha value of more than 0.7, both for the whole scale and its individual factors. It was shown that more negative stereotypes towards mentally ill offenders were correlated with less compassion and less desire for their rehabilitation, with stronger belief and conviction that they represent a danger to the community, with less diminished responsibility, and a lot fewer positive attitudes in general. Women, older people, individuals with a lower education level and participants with children were found to hold more negative attitudes. The ATMIO scale translated in Greek is the first tool to measure attitudes towards mentally ill offenders in the country and shows satisfactory internal consistency and interpretation of its four-factor structure. It is a comprehensible and easy-to-complete scale, which can become a reliable tool to record attitudes towards mentally ill offenders also in our country.

[Support for families with a mentally ill parent : Which forms of help do mentally ill parents utilize and which would they like to have?] / Unterstützung für Familien mit einem psychisch erkrankten Elternteil : Welche Hilfen nehmen psychisch erkrankte Eltern in Anspruch und welche wünschen sie sich?

BACKGROUND: In Germany different offers of social support are available for families that are provided by different sectors, e.g., the youth welfare and the healthcare systems. OBJECTIVE: Documentation of the utilized help, child-related factors that are associated with the utilization and the parental desires for support. MATERIAL AND METHODS: Survey of 160 parents undergoing (partial) inpatient treatment in psychiatric hospitals via an oral interview using standardized and semi-standardized instruments. RESULTS: The results show that nonprofessional help by family and friends as well as support offers provided by the healthcare system are used most frequently. Families that perceived their children as more burdened receive more help than families with children judged as being less burdened. There are regional differences especially in the utilization of high-threshold help by the healthcare system. DISCUSSION: Support offers seem to reach families with mental illnesses, especially those that are particularly burdened; however, there are regional differences regarding the utilization of support as well as the wishes for specific support offers.

The influence of patient-centered teaching on medical students' stigmatization of the mentally ill.

Aim: Stigmatization by healthcare workers poses a challenge to providing care to the mentally ill. Bedside teaching during undergraduate medical education offers students an opportunity to directly interact with patients with a range of psychiatric disorders and thereby gather reflective experience. The present study investigates if this supervised contact with mentally ill patients during a one-week clinical course on psychosomatic medicine leads to stigma reduction in medical students. The factors influencing stigmatization were also investigated. Method: This was a prospective, non-randomized, controlled interventional study done in the 2019/20 winter semester involving fourth-year medical students who attended a week-long practical block on psychosomatic medicine (intervention group). This group was compared to students who had attended a week-long practical block with a somatic focus during the same time period (control group). Stigmatization was measured before and immediately upon completion of the week using the MICA-4 scale. Data on age, sex, experience with the mentally ill, interest in psychiatry/psychosomatics, and sense of self-worth were also gathered prior to starting the practical block. Analysis of the sample of 143 students with a complete basic data set was carried out using mixed ANOVA, multiple linear regression and moderator analysis. Results: In the context of clinical teaching with psychiatric patients, the stigmatization of the mentally ill among medical students decreased significantly more in the intervention group compared to the students in the control group who received instruction on somatic topics (p=.019, η2p=.04). In addition, being female, having previous experience with the mentally ill and general interest in the subjects of psychiatry or psychosomatics at T0 associated with lower stigma. In contrast, stigmatization was increased at the beginning of the study in males and those with low self-esteem. A moderating effect of the factors on stigma reduction was not seen. Conclusion: Undergraduate clinical instruction that enables direct contact and reflective experiences with the mentally ill leads to a reduction in the stigmatizing attitudes held by medical students toward the mentally ill. This underscores the need to have practical clinical instruction using patients.

[Homelessness Among People with Mental Illness - Using the Example of a Growing German City]. / Wohnungslosigkeit bei psychisch erkrankten Menschen ­ Am Beispiel einer wachsenden deutschen Großstadt.

OBJECTIVE: The present study investigated the development of homelessness among people with mental illness using the example of a growing German city. METHODS: Eight psychosocial community centres estimated how many of their clients had become homeless in the previous year of care from 2008 to 2019. A random effects negative binominal (RENB) regression model was developed to investigate the change of homelessness over time. RESULTS: The number of homeless, mentally ill clients of the psychosocial community centres increased significantly from 2008 to 2019 (IRR=1.26; 95-CI=1.16-1.36; p<.001). Every year, homelessness had an average increase of 26%. CONCLUSION: The problem of homelessness among mentally ill people has worsened in the investigated region during the past few years. Existing support services must be assessed and community-based support services expanded.

"Helping Mentally Ill, a Reward Both in this Life and After": A Qualitative Study Among Community Health Professionals in Somaliland.

This study aimed to describe the experiences of community mental health workers, predominantly female, nurses and doctors providing community-based mental health services in Borama, Somaliland. A qualitative explorative study using focus group discussions was conducted. Data were collected from three focus group discussions with 22 female community health workers, two medical doctors, and two registered nurses and analyzed using content analysis with an inductive approach. Three main categories were identified from the analysis: (1) bridging the mental health gap in the community; (2) working in a constrained situation; and (3) being altruistic. Overall, the community mental health workers felt that their role was to bridge the mental health gap in the community. They described their work as a rewarding and motivated them to continue despite challenges and improving community healthcare workers' work conditions and providing resources in mental health services will contribute to strengthening mental health services in Somaliland.

What About Us? Experiences of Relatives Regarding Physician-Assisted Death for Patients Suffering from Mental Illness: A Qualitative Study.

Physician-assisted death (PAD) for patients suffering from mental illness is legally permitted in the Netherlands. Although patients' relatives are not entrusted with a legal role, former research revealed that physicians take into account the patient's social context and their well-being, in deciding whether or not to grant the request. However, these studies focussed on relatives' experiences in the context of PAD concerning patients with somatic illness. To date, nothing is known on their experiences in the context of PAD concerning the mentally ill. We studied the experiences of relatives with regard to a PAD request by patients suffering from mental illness. The data for this study were collected through 12 interviews with relatives of patients who have or had a PAD request because of a mental illness. We show that relatives are ambivalent regarding the patient's request for PAD and the following trajectory. Their ambivalence is characterised by their understanding of the wish to die and at the same time hoping that the patient would make another choice. Respondents' experiences regarding the process of the PAD request varied, from positive ('intimate') to negative ('extremely hard'). Some indicated that they wished to be more involved as they believe the road towards PAD should be a joint trajectory. To leave them out during such an important event is not only painful, but also harmful to the relative as it could potentially complicate their grieving process. Professional support during or after the PAD process was wanted by some, but not by all.

Self-reported influences on willingness to receive COVID-19 vaccines among physically ill, mentally ill, and healthy individuals.

OBJECTIVE: Individuals with mental and physical disorders have been disproportionately affected by adverse health outcomes due to the COVID-19 pandemic, and yet vaccine hesitancy persists despite clear evidence of health benefits. Therefore, our study explored factors influencing willingness to receive a COVID-19 vaccine. METHODS: Individuals with mental illness (n = 332), physical illness (n = 331), and no health issues (n = 328) were recruited via Amazon Mechanical Turk. Participants rated willingness to obtain a fully approved COVID-19 vaccine or a vaccine approved only for experimental/emergency use and influences in six domains upon their views. We examined differences by health status. RESULTS: Participants across groups were moderately willing to receive a COVID-19 vaccine. Perceived risk was negatively associated with willingness. Participants differentiated between vaccine risk by approval stage and were less willing to receive an experimental vaccine. Individuals with mental illness rated risk of both vaccines similarly to healthy individuals. Individuals with physical illness expressed less willingness to receive an experimental vaccine. Domain influences differently affected willingness by health status as well as by vaccine approval status. CONCLUSIONS: Our findings are reassuring regarding the ability of people with mental disorders to appreciate risk in medical decision-making and the ability of people of varied health backgrounds to distinguish between the benefits and risks of clinical care and research, refuting the prevailing notions of psychiatric exceptionalism and therapeutic misconception. Our findings shine a light on potential paths forward to support vaccine acceptance.

Traditional, religious, and cultural perspectives on mental illness: a qualitative study on causal beliefs and treatment use.

PURPOSE: Limited information is known from studies regarding traditional, religious, and cultural perspectives on mental illness and the use of traditional and alternative therapies by mentally ill people in Indonesia. This study explored traditional, religious, and cultural beliefs about causes of mental illness and the use of traditional/alternative treatments for mentally ill patients. METHOD: We adopted a qualitative content analysis method as proposed by Schreier. This study was conducted at a mental Hospital in Indonesia. We interviewed 15 nurses and 15 patients. Data were analysed using qualitative content analysis method. RESULTS: Five discrete but interrelated themes emerged: 1) Possessed illness and belief in supernatural forces; 2) Sinful or cursed illness; 3) Witchcraft or human-made illness; 4) traditional/alternative treatments; and 5) Barriers to treatment of mental illness. CONCLUSION: Traditional/alternative treatments play an important role in meeting the need for mental health treatment. The findings are relevant for mental health nurses who provide direct to their patients, and for other areas of mental health practice. We also found a lack of knowledge about the causes of mental illness among patients and families. Education should be at the heart of mental health promotion to raise the level of mental health literacy in Indonesia.

Abordar a la persona entre trayectorias alcohólicas y tratamientos / Approaching the person between alcoholic trajectories and treatments

Este artículo es un trabajo de investigación etnográfica en el campo sanitario. Sus objetivos son reconstruir trayectorias de personas con trastornos mentales y de comportamiento por uso de alcohol y visibilizar representaciones y prácticas en los tratamientos brindados en el Hospital Vilardebó (Uruguay), en torno a dichos itinerarios. Las narrativas de los pacientes estudiados dan cuenta de una ruptura biográfica ocurrida mayoritariamente en la adolescencia, cuando comienza un consumo problemático de alcohol que lleva a una reorganización de la identidad social de orden simbólico; refirieren también, la mayoría de ellos, estar disconformes con la asistencia que se les brinda, y reclaman ser más escuchados. Por otra parte, en lo referente a las representaciones formuladas por los funcionarios entrevistados, a mayor formación y experiencia de ejercicio profesional, hay mayores críticas a la atención que se brinda a estos usuarios. De ahí que la confluencia de Antropología y Salud, ensamblando cultura y cuidado, permite integrar a las dimensiones físicas los aspectos emocionales, familiares, culturales y sociales.

This article is carries out ethnographic research in the sanitary field. Its objectives are to reconstruct the trajectories of people with mental and behavioral disorders due to alcohol use and to make visible representations and practices in treatments provided at Hospital Vilardebó (Uruguay). Patients' narratives show a biographical rupture occurring mainly during adolescence. Problematic alcohol use begins soon after, leading to a reorganization of symbolic social identity. Most patients are not satisfied with care provided, and demand to be listened to more extensively. As for health care workers' representations, the greater the training and professional expertise, the greater the criticism of provided care. Hence, the confluence of Anthropology and Health, combining culture and care, makes possible the emotional, family, cultural and social aspects to be integrated into the physical ones.

Between self-stigma and the will of recovery... Difficulties in accepting a psychiatric diagnosis - case study. / Pomiedzy self-stygma a wola zdrowienia... Trudnosci z akceptacja diagnozy psychiatrycznej ­ studium przypadku.

The consequence of social exclusion of the mentally ill patients is often a worsening of the course of the disease and prognosis. The psychiatric diagnosis is very important for the so-called labeling, which is one of the stages of the stigma process, and it also has a lot of social implications. The purpose of this work is to take look at the issue of psychiatric diagnosis, especially the diagnosis of paranoid schizophrenia and its consequences for the patient's social functioning. The authors of the article have reviewed the literature on the importance of psychiatric diagnosis in the context of self-stigmatization of mental illness and have presented, based on medical records, a clinical case of a patient who had significant difficulties in accepting the diagnosis of paranoid schizophrenia. The stigma of mental illness is the reason of subjectively experienced suffering for people with psychiatric diagnosis and their relatives, but it is also relevant to public health. Psychiatric diagnosis has significant social consequences, which is why it is so important that the process of diagnosis is not a routine activity for psychiatrists, free from ethical reflection.

A six-session group-based pilot intervention for alcohol and other drug use in hospitalised mentally ill young offenders.

OBJECTIVE: This study aims to evaluate a group-based intervention for alcohol and other drug (AOD) use offered to incarcerated youth hospitalised with mental illness. METHODS: A six-session group-based intervention for AOD use was offered to young offenders with mental illness, hospitalised in the Adolescent Unit of the Forensic Hospital, Sydney, between June 2015 and May 2017. Pre- and post-intervention measures were collected using the Brief Psychiatric Rating Scale (BPRS), Treatment Entry Questionnaire, Drug-Related Locus of Control (DRLOC) and Drug-Taking Confidence Questionnaire, short version. RESULTS: Pre- and post-intervention measures were compared utilising paired t-tests. Following the intervention, there was a significant reduction in the severity of psychiatric symptoms rated using the BPRS and a significant difference in DRLOC measures, reflecting increased internal locus of control. CONCLUSIONS: Improved internal drivers for reducing AOD use and improvement in symptoms of mental illness suggest similar interventions may be beneficial and may not impact recovery even during episodes of acute illness.

Stakeholders facilitating hope and empowerment amidst social suffering: A qualitative documentary analysis exploring lives of homeless women with mental illness.

BACKGROUND: Globally homeless mentally ill (HMI) individuals are considered one of the most vulnerable populations. An individual-centric, psychopathology-oriented focus of the existing mental health-care system limits the understanding of the HMI individuals through the disability lens overlooking their strengths and resilience that enable them to survive extremely hostile environments. Contemporary mental health research has embraced a paradigm shift that allows researchers to look beyond the predominant medical model to give precedence to a socio-culturally contexted and experientially firm understanding of human behaviour. AIM: Through the theoretical lens of social suffering, this article attempts to understand the lived experiences of the HMI women, the perspective of their caregivers and the standpoint of service providers in the context of homelessness and mental illness. METHODOLOGY: A documentary analysis as a qualitative research methodology has been used to reflect upon the concerns mentioned above. Following Figueroa's approach to the analysis of audio-visual texts, the documentary Lapata Zindagi, directed by Radhika Lata Murthy, has woven the stories of four HMI women and their caregivers have been analysed. The two-phased analysis involved constructivist grounded theory procedures. RESULTS: The methodological steps, rigour and the resulting categories (experience of social suffering associated with homelessness among HMI women, denial of care and rights within patriarchy, helplessness associated with the burden of caregiving and roles of NGO and community in building hope and empowerment) have been discussed through the lens of social suffering and how stakeholders might facilitate hope and empowerment amidst it. CONCLUSION: The article highlights the dire and urgent need to integrate mental health into primary health care and community-based intervention and move beyond clinical recovery to nurture 'hope' to enable recovery and empowerment for such marginalised populations.

Post-incident reviews after restraints-Potential and pitfalls. Patients' experiences and considerations.

WHAT IS KNOWN ABOUT THE SUBJECT?: Restraint has negative psychological, physical and relational consequences for mental health patients and care providers. Several countries have implemented seclusion and restraint (S/R) reduction programmes in which post-incident reviews (PIRs) including patients and care providers are one of several strategies. Existing knowledge indicates that PIRs have the potential to contribute to S/R prevention, but knowledge of the patients' perspectives on PIRs is scarce. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides in-depth knowledge about patients' experiences of being participants in PIRs after restraint events. Patients experience PIRs to result in being strengthened and developing new coping strategies. The paper reveals pitfalls when planning and conducting PIRs that make patients experience PIRs as meaningless, feel objectified or long for living communication and closeness. The patients' mental state, the quality of the relationships and the services' care philosophies, influence patients' experiences of PIRs as supporting their personal recovery processes or as continuation of coercive contexts. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Patients' vulnerability during the PIRs must be acknowledged. Trusted persons or advocacy must support the patient in the PIR and thus reduce the power-dependence imbalance. The PIR must be conducted in a supportive, non-punishing atmosphere. Patients must influence planning for the PIR concerning time point and participants and themes to be discussed. The PIR forms should be extended to support the patients' empowerment and well-being. ABSTRACT: Introduction Post-incident reviews (PIRs), including patients, nurses and other care providers, following incidents of restraints are recommended in mental health services. Few studies have examined patients' experiences and considerations concerning PIRs. Aim The study aims to explore patients' perspectives on PIRs in relation to how they experience participation in PIRs and further view PIRs' potential for care improvement and restraint prevention. Method We conducted a qualitative study based on individual interviews. Eight current and previous inpatients from two Norwegian mental health services were interviewed. Results The patients experienced PIRs as variations on a continuum from being strengthened, developing new coping strategies and processing the restraint event to at the other end of the continuum; PIRs as meaningless, feeling objectified and longing for living communication and closeness. Discussion PIRs' beneficial potential is extended in the study. The findings highlight however that personal and institutional conditions influence whether patients experience PIRs as an arena for recovery promotion or PIRs as continuation of coercive contexts. Implications for practice We recommend patients' active participation in planning the PIR. PIRs should be conducted in a supportive atmosphere, including trusted persons, emphasizing and acknowledging a dialogical approach.

Exploring Mechanisms of Mental Illness Stigma Reduction in Asian Canadian Men.

OBJECTIVE: Although there is evidence of effective stigma reduction by various psychological and educational interventions, the mechanisms of change remain unclear. In this article, we examine hypothesized processes that might have mediated reductions in stigma observed among Asian men who had received in mental health promotion interventions in Greater Toronto Area, Canada. METHOD: Our sample consisted of 495 Asian men, who received either acceptance and commitment therapy (ACT; n = 133), contact-based empowerment education (CEE; n = 149), combination of ACT and CEE (n = 152), or psychoeducation (n = 61). Group differences on intervention outcomes, including stigmatizing attitudes (Community Attitudes toward the Mentally Ill), internalized stigma (Internalized Stigma of Mental Illness), valued living (Valued Living Questionnaire), and attitudes to engage in social change (Social Justice Scale) were hypothesized to be due to the impact of the different interventions and mediated by changes in specific underlying psychological processes. These process-related changes were modelled using measures of mindfulness (Freiburg Mindfulness Inventory), psychological flexibility (Acceptance and Action Questionnaire version II), and empowerment (Empowerment Scale [ES]). Their pre- and post changes were analyzed with repeated measures analysis of variance, and mediational analyses were performed. RESULTS: Findings from mediational analyses suggest that empowerment (ES) mediated a significant portion of the effects observed in reduction in stigmatizing attitudes and internalized stigma across intervention groups (t = 3.67 to 3.78 for CEE groups, and t = 4.32 to 4.56 for ACT groups). For the ACT groups, reduction in internalized stigma might also have been partly mediated by psychological flexibility, an intervention-specific psychological process. CONCLUSIONS: Results from the current study suggest that different stigma reduction interventions may be mediated by increased empowerment as a common mechanism of change, while intervention-specific mechanism of change, improved psychological flexibility through ACT, may also contribute to improvement in internalized stigma.

Health risk behaviours among people with severe mental ill health during the COVID-19 pandemic: Analysis of linked cohort data.

BACKGROUND: People with severe mental ill health (SMI) experience a mortality gap of 15-20 years. COVID-19 has amplified population health inequalities, and there is concern that people with SMI will be disproportionately affected. Understanding how health risk behaviours have changed during the pandemic is important when developing strategies to mitigate future increases in health inequalities. METHODS: We sampled from an existing cohort of people with SMI. Researchers contacted participants by phone or post to invite them to take part in a survey about how the pandemic had affected them. We asked people about their health risk behaviours and how these had changed during the pandemic. We created an index of changed behaviours, comprising dietary factors, smoking, lack of exercise, and drinking patterns. By creating data linkages, we compared their responses during pandemic restrictions to responses they gave prior to the pandemic. OUTCOMES: 367 people provided health risk data. The mean age of the participants was 50.5 (range = 20 to 86, SD ± 15.69) with 51.0% male and 77.4% white British. 47.5% of participants reported taking less physical activity during the pandemic and of those who smoke 54.5% reported smoking more heavily. Self-reported deterioration in physical health was significantly associated with an increase in health risk behaviours (adjusted OR for physical health 1.59, 95%CI 1.22-2.07; adjusted OR for Age 0.99, 95%CI 0.98-1.00). INTERPRETATION: COVID-19 is likely to amplify health inequalities for people with SMI. Health services should target health risk behaviours for people with SMI to mitigate the immediate and long lasting impacts of the COVID-19 pandemic.

Psychological Impact of Masks and Infection-Prevention Plastic Partitions on Anxiety for Infection and Patient-Doctor Relationships During the COVID-19 Pandemic.

Objective: To investigate the impact of masks and plastic partitions on patient-doctor communication and subjective anxiety for infection in patients with psychiatric disorders.Methods: Subjects were patients who visited a psychiatric clinic in Japan from April 27 to August 31, 2020. Anxiety of being infected and the psychological barrier to communication were evaluated on a 5-point scale.Results: The final analysis included 425 patients. Most participants answered that there was no change with regard to communication when the doctor was wearing a mask (n = 353, 91.0%) or using a plastic partition (n = 318, 82.8%). Most participants responded that anxiety for being infected was very mild, a little mild, or not changed by the doctor wearing a mask and using a plastic partition. Most participants felt significantly less anxiety with the doctor wearing a mask/using a plastic partition before than after the state of emergency declaration (P = .005 for mask and P < .001 for plastic partition). Participants in the older age range felt significantly higher anxiety compared to those in the younger and middle age range groups from doctors wearing masks (P < .001) and compared to those in the middle age range group from plastic partitions (P = .001).Conclusions: Use of masks and plastic partitions in psychiatric practice is recommended, as it may result in reduction of anxiety for infection without affecting patient-doctor communication in patients with psychiatric disorders. The generalizability of the results of the present study should be tested.