Clinical practice guideline recommendations to improve the mental health of adult trauma patients: protocol for a systematic review.

INTRODUCTION: Mental disorders are common in adult patients with traumatic injuries. To limit the burden of poor psychological well-being in this population, recognised authorities have issued recommendations through clinical practice guidelines (CPGs). However, the uptake of evidence-based recommendations to improve the mental health of trauma patients has been low until recently. This may be explained by the complexity of optimising mental health practices and interpretating CGPs scope and quality. Our aim is to systematically review CPG mental health recommendations in the context of trauma care and appraise their quality. METHODS AND ANALYSIS: We will identify CPG through a search strategy applied to Medline, Embase, CINAHL, PsycINFO and Web of Science databases, as well as guidelines repositories and websites of trauma associations. We will target CPGs on adult and acute trauma populations including at least one recommendation on any prevention, screening, assessment, intervention, patient and family engagement, referral or follow-up procedure related to mental health endorsed by recognised organisations in high-income countries. No language limitations will be applied, and we will limit the search to the last 15 years. Pairs of reviewers will independently screen titles, abstracts, full texts, and carry out data extraction and quality assessment of CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE) II. We will synthesise the evidence on recommendations for CPGs rated as moderate or high quality using a matrix based on the Grading of Recommendations Assessment, Development and Evaluation quality of evidence, strength of recommendation, health and social determinants and whether recommendations were made using a population-based approach. ETHICS AND DISSEMINATION: Ethics approval is not required, as we will conduct secondary analysis of published data. The results will be disseminated in a peer-reviewed journal, at international and national scientific meetings. Accessible summary will be distributed to interested parties through professional, healthcare quality and persons with lived experience associations. PROSPERO REGISTRATION NUMBER: (ID454728).

[Short-term interventions offered by les centres locaux de services communautaires (CLSC) to people living with anxiety or depressive disorders: Results of the longitudinal component of the Shared Knowledge study]. / Les interventions de courte durée offertes par les centres locaux de services communautaires (CLSC) aux personnes traversant un épisode de troubles anxieux ou dépressifs : une étude longitudinale au Québec.

Context In Quebec, adult mental health (AMH) first-line teams are mandated to provide psychosocial services to people living with mental health difficulties, including anxiety and mood disorders. Following the establishment of new clinical guidelines in 2017, the duration of interventions was not to exceed 15 sessions, with some exceptions. Objectives The overall aim of the longitudinal component of the Shared Knowledge study was to evaluate the care experience of individuals with an anxiety or depressive disorder receiving a short-term intervention (<15 sessions) by first-line AMH teams, and the evolution of recovery over time. Specifically, the objectives were to: 1) determine the appreciation of short-term interventions by service users; and 2) assess the evolution over time of the symptomatology, functioning and quality of life and recovery of individuals receiving short-term interventions. Method A mixed method longitudinal design was used. Telephone interviews were conducted with participants, in which the following variables were quantitatively and qualitatively assessed: appreciation of services received, quality of relationship with the provider (INSPIRE), depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), global functioning (WHODAS), quality of life (ReQOL), and personal recovery (ERTAD). Linear mixed model analyses were performed to examine changes over time on quantitative measures. Content analysis was performed on the qualitative data. Results A total of 63 individuals participated in an interview before the start of their intervention and 22 of them participated after the end of this intervention. Statistical analyses showed a significant improvement in anxiety symptoms, quality of life, and personal recovery, but no difference was observed in depressive symptoms and level of functioning. Nearly half (47.4%) of participants reported that the intervention they received had "completely" met the need that had led them to seek help, and 33.3% felt "completely" equipped or empowered in their recovery. The quality of the relationship with the caregiver, the opportunity to take part in decision-making, and the personalization of the intervention according to their needs and preferences were some of the elements that were particularly appreciated. Conclusion Short-term interventions seem to be appreciated and produce positive effects in many people suffering from anxiety or depressive disorders. However, they remain insufficient for a number of them. A personal recovery measure should be used in conjunction with symptomatology and functioning scales to monitor the progress of people using first-line mental health services.

Profiles of Recovery from Mood and Anxiety Disorders: A Person-Centered Exploration of People's Engagement in Self-Management.

CONTEXT: A shift toward person-centered care has been occurring in services provided to people with mood and anxiety disorders. Recovery is recognized as encompassing personal aspects in addition to clinical ones. Guidelines now recommend supporting people's engagement in self-management as a complementary recovery avenue. Yet the literature lacks evidence on how individualized combinations of self-management strategies used by people relate to their clinical and personal recovery indicators. OBJECTIVES: The aims of this study were to identify profiles underlying mental health recovery, describe the characteristics of participants corresponding to each profile, and examine the associations of profiles with criterion variables. METHOD: 149 people recovering from anxiety, depressive, or bipolar disorders completed questionnaires on self-management, clinical recovery (symptom severity), personal recovery (positive mental health), and criterion variables (personal goal appraisal, social participation, self-care abilities, coping). RESULTS: Latent profile analysis (LPA) revealed three profiles. The Floundering profile included participants who rarely used self-management strategies and had moderately severe symptoms and the lowest positive mental health. The Flourishing profile was characterized by frequent use of self-empowerment strategies, the least severe symptoms, and the highest positive mental health. Participants in the Struggling profile engaged actively in several self-management strategies focused on symptom reduction and healthy lifestyle. They concomitantly reported high symptom severity and moderately high positive mental health. The study revealed that Floundering was associated with higher probabilities of being a man, being single, and having a low income. People in the Flourishing profile had the most favorable scores on criterion variables, supporting the profiles' construct validity. DISCUSSION: The mixed portrait of Struggling participants on recovery indicators suggests the relationship between health engagement and recovery is more intricate than anticipated. Practitioners should strive for a holistic understanding of their clients' self-management strategies and recovery indicators to provide support personalized to their profile. While people presenting risk factors would benefit from person-centered support, societal efforts are needed in the long term to reduce global health inequalities. The integration of constructs from diverse fields (patient-centered care, chronic illness, positive psychology) and the use of person-oriented analysis yielded new insights into people's engagement in their health and well-being.

Mental health self-management questionnaire: Development and psychometric properties.

BACKGROUND: Through self-management, people living with depression, anxiety or bipolar disorders can play an active role in their recovery. However, absence of a validated questionnaire limits empirical research on self-management. The study aimed to develop a French instrument, the Mental Health Self-Management Questionnaire (MHSQ), and to investigate its psychometric properties METHODS: A pool of 86 items was created based on a qualitative study with 50 people in recovery from depression, anxiety or bipolar disorders. The 64 most pertinent items were identified following ratings from 14 experts. A sample of 149 people in recovery completed these items and criterion-related measures (specific aspects of self-management, clinical and personal recovery, social desirability), and 93 participants also completed MHSQ two weeks later RESULTS: Exploratory and confirmatory factor analyses show that MHSQ is composed of three subscales: Clinical (getting help and using resources), Empowerment (building upon strengths and positive self-concept to gain control) and Vitality (active and healthy lifestyle). These subscales had satisfying consistency and test-retest reliability, and were mostly unrelated to social desirability. Correlations with criterion variables support convergent and concurrent validity, especially for Empowerment and Vitality. Comparison of structural models provides evidence of the distinct nature of MHSQ in comparison to the constructs of clinical and personal recovery LIMITATIONS: Longitudinal studies with larger samples are needed to explore the validity of MHSQ for predicting recovery over time CONCLUSION: MHSQ is a psychometrically-sound instrument, useful for establishing the role of self-management in recovery and monitoring the efficacy of self-management support programs.

Self-Management Strategies in Recovery From Mood and Anxiety Disorders.

Mood and anxiety disorders are the most prevalent mental disorders. People with such disorders implement self-management strategies to reduce or prevent their symptoms and to optimize their health and well-being. Even though self-management strategies are known to be essential to recovery, few researchers have examined them. The aim of this study is to explore strategies used by people recovering from depressive, anxiety, and bipolar disorders by asking 50 of them to describe their own strategies. Strategies were classified according to dimensions of recovery: social, existential, functional, physical, and clinical. Within these themes, 60 distinct strategies were found to be used synergistically to promote personal recovery as well as symptom reduction. Findings highlight the diversity of strategies used by people, whether they have depressive, anxiety, or bipolar disorders. This study underscores the importance of supporting self-management in a way that respects individual experience.

Predictors of caregiver satisfaction with mental health services.

The objective of this study is to examine the relative contribution of three main factors (characteristics of services and service providers, characteristics of patients and caregivers, and impact of psychiatric illness) to caregiver satisfaction with services. Results of this study are based on the responses of 154 family caregivers of individuals with mental illnesses in Quebec, and indicate that these aspects play a predictive role in caregiver satisfaction with services. A multiple regression model explained 42% of the variance in satisfaction. Collaboration with professionals is the key determinant in the model, as it contributes more than any other variable to satisfaction. Results demonstrate the importance of obtaining a better understanding of caregivers' satisfaction with services in order to increase their involvement in community integration.

What does recovery mean for me? Perspectives of Canadian mental health consumers.

OBJECTIVE: The objective of this study was to explore the meaning of recovery from the perspectives of consumers receiving mental health services in Canada. METHODS: Sixty semi-structured interviews were conducted with 54 mental health consumers in Montreal, Québec City and Waterloo-Guelph, Ontario. RESULTS: Two contrasting meanings of recovery emerged. The first definition strongly attached recovery to illness while the second definition linked recovery to self-determination and taking responsibility for life. CONCLUSIONS: The prominence of biomedical definitions of recovery suggests the need to find common ground between these two perspectives, if conceptualizations of recovery are to include the views of consumers who routinely experience the mental health system.

Role of psychological factors in studying recovery from a transactional stress-coping approach: implications for mental health nursing practices.

Over the last decade, the experience of recovering from psychiatric disabilities has received increased attention in mental health nursing. Recovery is a complex experience that can be understood in terms of construct, process, and outcomes. New theoretical frameworks are needed to better understand antecedents, process variables, and outcomes related to recovery. Considering that recovery is a stressful and challenging experience, the transactional stress-coping theory appears relevant to explore the appraisal and coping processes involved in recovery. Based on this theory, a new framework has been built to better understand the phenomenon of stress in recovery. More specifically, a review of the recovery literature had led to the identification of several key recovery concepts, which were then linked to major stress-coping concepts, namely contextual factors, potential stressors, primary and secondary appraisals, coping strategies, and short-term and long-term outcomes. This paper focuses on specific types of personal characteristics that are included in the broad category of contextual factors, namely psychological factors. These factors may act as coping resources, helping people to deal successfully with events interfering with the achievement of recovery goals. The main purpose of this paper is to offer a detailed discussion about how mental health nursing practices may promote the role of psychological factors within the stress-coping process. Three categories of psychological factors are discussed: views about oneself, psychological empowerment, and personal/philosophical orientations in life. A brief summary of the new framework is first offered to introduce its major concepts and basic mechanisms.

The role of relatives in discharge planning from psychiatric hospitals: the perspective of patients and their relatives.

This study prospectively assessed the preferences and satisfaction of 98 psychiatric inpatients and 40 of their relatives with family involvement in discharge planning. Preferences questionnaires were administered during hospitalization. Satisfaction questionnaires were completed 3 months later. Preferences noted by most participants included information concerning patient health status, ways to prevent further hospitalizations, services for relatives, and signs of patient decompensation. More relatives than patients felt that post-discharge residence and activities were important areas to be involved in. Most participants were satisfied if relatives were involved in discharge planning. However, up to 89% of patients, and 84% of relatives, reported no communication between clinical staff and relatives regarding discharge. When this was the case, satisfaction rates dropped sharply, especially for relatives. The need for increased communication between clinicians and relatives regarding discharge planning remains a problem.

[Hearing voices: new paths for clinical practice and research]. / Entendre des voix: nouvelles voies ouvrant sur la pratique et la recherche.

This theoretical article reviews the scientific literature regarding the phenomenon of auditory hallucinations of people who are with or without a psychiatric diagnosis. Based on the conceptual model of the Disability Creation Process (Fougeyrollas et al., 1998), the authors describe the factors and mechanisms involved in this phenomenon in a systemic perspective. Finally, the authors examine future directions in intervention and research to favor the social participation of people who hear voices.

The role of work in the recovery of persons with psychiatric disabilities.

This study explored the role of work in the recovery of employed and unemployed persons with psychiatric disabilities. Fourteen persons with psychiatric disabilities participated in semi-structured interviews. Content analysis revealed that the experience of recovery was based on six major dimensions: self-definition, empowerment, connections to others, meaning of work, vocational future, and meaning of recovery. Differences in these six dimensions led to the identification of three profiles of recovery: recovery as uncertain, recovery as a self-empowering experience, and recovery as a challenging experience. Each profile described a specific context in which participation in work or avoidance of work can be understood and vocational interventions can be designed.

[The experience of recovery : Theoretical perspectives.]. / L'expérience du rétablissement : perspectives théoriques.

The experience of recovery is increasingly recognized as an important phenomenon in the promotion of a state of well-being of people with mental disorders. This article offers an initial effort of conceptualizing the experience of recovery. A definition of recovery is first proposed followed by a literature review, where recovery is discussed through four related dimensions: 1) redefining and expansion of self, 2) temporality, 3) empowerment, and 4) relationships with others. Finally, future directions in research are suggested to further explore the experience of recovery in different areas.

[Work as a social determinant of health for mental health services consumers.]. / Le travail comme déterminant social de la santé pour les personnes utilisatrices des services de santé mentale (notes de recherche).

Deinstitutionalization policies of psychiatric services have led to a massive return of former psychiatric patients in society. In accordance with social determinants of health and well-being, the authors sustain that actions led outside the hospital environment are the most favorable to mental health services consumers. On the list of the social determinants, work must be placed on top and constitutes a major factor of social integration. Yet, only 15 % of former psychiatric patients succeed in integrating the regular labour market. There is still very little research explaining this reality. Our research team from the GRASP (Groupe de recherche sur les aspects sociaux de la santé et de la prévention)/Centre FCAR whishes to correct this situation by analyzing links between mental health and work with the help of notions relative to social capital, territory, empowerment, intersectorial divisions and recovery.

[Caregivers: their perspective on mental health services offered to relatives.]. / Le point de vue des aidants familiaux sur les services en santé mentale offerts à leurs proches.

The current study has been conducted with 40 caregivers who are part of family support groups of people suffering of mental disorders. These caregivers have been interviewed individually in order to document their opinion on mental health services offered to their relatives. Analysis of their comments indicate both the expression of satisfaction and lack of it regarding organisation of services by most participants. However, the issue of service organisation, and more specifically in relation with access, entail the greatest number of comments of dissatisfaction.

[Attitudes and beliefs of citizens of Montreal towards psychiatric patients living in a society]. / Attitudes et croyances des Montréalais et Montréalaises à l'égard des ex-patients psychiatriques vivant dans la société.

In the past 50 years, new health policies all over the world have led to the introduction of rehabilitation and deinstitutionalization programs to overcome the depersonalizing effects of asylums. As a result, large numbers of former psychiatric patients are now living and working in society. The public's attitudes and beliefs about these former patients play a central role in their harmonious integration into the community. To find out more about these attitudes and beliefs, we interviewed a representative sample of the population of Montreal Island (n = 899). Our study indicates that a majority of respondents show a favourable attitude towards former psychiatric patients (in terms of recognizing their rights, accepting them in the workplace, creating warm relationships, etc.), but that people still entertain many negative beliefs (seeing mental illness as a deviation from the norm). The study interprets these ambivalent signs of tolerance and fear towards ex-psychiatric patients among Montrealers. An encouraging sign is that a trend towards greater acceptance seems to be emerging among young people in terms of both attitudes and beliefs.