Measuring the utility of brief psychological intervention in psychiatric hospitals: A call for change.

OBJECTIVE: Despite the known importance of regularly monitoring progress when delivering psychological interventions, this is not mandated or seemingly even common practice on Australian inpatient psychiatric wards. Barriers for why this might be the case are described, an argument made to rise above them, and a call for research in this area is made. CONCLUSIONS: Failure to find ways to collect, analyse and be transparent with data around brief inpatient psychological interventions can diminish treatment outcomes and leaves us open to criticism as a profession.

Psychological interventions for pre-event and post-event rumination in social anxiety: A systematic review and meta-analysis.

Pre-event and post-event rumination have been consistently identified by cognitive models as important maintaining factors in Social Anxiety Disorder (SAD). This systematic review and meta-analysis aimed to investigate the effectiveness of psychological treatment in reducing pre-event and post-event rumination in adults with social anxiety. A comprehensive literature search identified 26 eligible studies, with 1524 total participants. Psychological treatments demonstrated large significant within-group effect sizes (from pre- to post-treatment) in reducing pre-event rumination (g = 0.86) and post-event rumination (g = 0.83). Subgroups analysed showed CBT to have large significant effect sizes in reducing pre-event rumination (g = 0.97) and post-event rumination (g = 0.85). Interventions that specifically addressed rumination were found to be significantly more effective in reducing pre-event rumination than those that did not (p = .006). Both individual and group treatment formats were equally effective in reducing pre-event rumination and post-event rumination. Meta-regressions revealed that pre-event rumination treatment effects were significantly larger in individuals with higher baseline social anxiety, meanwhile post-event rumination treatment effects were larger for those with higher baseline depression. Overall findings show that pre-event and post-event rumination are effectively reduced through psychological treatment, and clinical implications for the enhancement of evidence-based treatment protocols are discussed.

Psychometric properties of the state Probability and Consequences Questionnaire for social anxiety disorder.

Cognitive models of social anxiety propose that overestimation of the probability and cost of negative evaluation plays a central role in maintaining the disorder. However, there are currently no self-report state-based measures of probability and cost appraisals. The current paper examines the psychometric properties of the Probability and Consequences Questionnaire for social anxiety (PCQ-SA), which measures probability and consequence appraisals both in anticipation of, and in response to, an impromptu speech task. A total of 532 participants were recruited for the present study, consisting of 409 participants with a principal diagnosis of Social Anxiety Disorder (SAD), and 123 non-clinical controls. Results of exploratory and confirmatory factor analyses supported a two-factor solution for the PCQ-SA. The PCQ-SA demonstrated excellent internal consistency, excellent test-retest reliability, good convergent validity at both time points (i.e., pre and post speech task), and sensitivity to treatment. Finally, using Receiver Operating Characteristic Curve Analysis, clinical cut-off scores were calculated for probability and consequences at both time points, with the PCQ-SA scales showing good sensitivity, specificity, and positive and negative predictive values. Overall, the results provide evidence that the PCQ-SA possesses excellent psychometric properties. The PCQ-SA is suitable for use in clinical and research settings to assess key cognitive maintaining factors for SAD.

Measuring state pre-event and post-event rumination in Social Anxiety Disorder: Psychometric properties of the Socially Anxious Rumination Questionnaire (SARQ).

Cognitive models have consistently recognised pre-event and post-event rumination as maintaining factors in Social Anxiety Disorder (SAD). This study aimed to investigate the psychometric properties of a state-based measure of pre-event and post-event rumination in SAD: The Socially Anxious Rumination Questionnaire (SARQ), which was formerly known as the Thoughts Questionnaire. In particular, we examined the factor structure, internal consistency, test-retest reliability, construct validity, sensitivity to treatment response, clinical cut-off scores (relative to non-clinical participants), and associated test performance indicators of the SARQ. The sample comprised 505 adults with a principal diagnosis of SAD and 130 non-clinical controls. Pre-event and post-event rumination were assessed in relation to a three-minute impromptu speech. Results indicated single factors for the SARQ: Pre-event and SARQ: Post-event scales, along with excellent internal consistency, good test-retest reliability, sound sensitivity to cognitive-behavioural treatment response, and a clear ability to discriminate between individuals with a principal diagnosis of SAD and non-clinical controls. The findings justify the SARQ's use as a robust and reliable measure of state rumination for individuals with SAD that can be used both before and after encountering a social threat.

Factors influencing inpatients perception of psychiatric hospitals: A meta-review of the literature.

Inpatient psychiatric hospitals have remained a standard aspect of mental health treatment for many centuries. While numerous treatments have been empirically validated to assist inpatients, less is known about how inpatients perceive psychiatric hospitals. A meta-review, which is a systematic review of systematic reviews, was conducted to examine the factors reported by inpatients which affect their perception of psychiatric hospitals. MEDLINE, PsycINFO and EMBASE were systematically searched. Reviews that considered the perception of adults with mental illness admitted to an inpatient psychiatric hospital were eligible for inclusion. The AMSTAR-2 was used to assess for methodological quality and bias of eligible reviews, with reviews judged to have critical issues excluded. Thematic synthesis was used to detect key overarching factors that generalised across multiple reviews. Twelve systematic reviews were included of which seven key factors were extracted. These were; relationships on the ward, the ward environment, coercive measures, legal status, autonomy, feeling deserving of care, and expectations of care at admission and discharge. Inpatients report several factors that need to be considered when creating a therapeutic environment in a psychiatric hospital. While the importance of therapeutic rapport was the most consistently referenced factor in the included reviews, all factors are likely interwoven and modifiable. Limitations of this meta-review and directions for future research are discussed.

A hotel room on Mars: quarantine and the psychological view from the virtual front line.

OBJECTIVE: Because of the COVID-19 pandemic, the implementation of quarantine for returning travellers and the effect this has on people's mental health has become a topical issue. This article briefly describes the historical context of quarantine, research around its impact on people's well-being, and the experiences of a clinical psychologist providing support to people in quarantine. CONCLUSIONS: Mental health professionals are in a unique position to assist people in quarantine, both in terms of counselling and ongoing research.

Banning pre-event rumination in social anxiety: A preliminary randomized trial.

BACKGROUND AND OBJECTIVES: Pre-event rumination has a clear role in maintaining social anxiety according to cognitive models. However, it is unclear what specific strategies can address pre-event rumination for individuals diagnosed with SAD. The current study aimed to determine the effectiveness of a brief intervention on multiple aspects of pre-event rumination, state anxiety and performance and threat appraisals. Additionally, the trajectory of pre-event rumination was investigated over four days. METHODS: Participants with SAD were informed they would be required to complete a speech task in four days' time and were randomised to an intervention (n = 27) or a non-active control group (n = 25). The intervention group were instructed to "ban" pre-event rumination using a metacognitive therapy technique known as detached mindfulness. All participants completed daily measures of pre-evet rumination that assessed frequency, uncontrollability, engagement and distress associated with pre-event rumination. On the day of the speech task, participants also completed state and cognitive measures before delivering the speech task. RESULTS: The intervention group reported reduced frequency, uncontrollability and distress associated with pre-event rumination, compared to the control group. There was no difference between groups for performance and threat appraisals as well as state anxiety. Rumination is a stable and robust process, with an increase in frequency and associated distress 24 hours before a feared social situation. LIMITATIONS: The lack of an active control group precludes comparisons to more traditional cognitive-behavioural therapy strategies for pre-event rumination. CONCLUSIONS: Pre-event rumination is a durable process but banning pre-event rumination using metacognitive therapy techniques shows promise for specifically addressing this maladaptive process.

Processes and pathways mediating the experience of social anxiety and negative rumination.

Negative rumination in social anxiety disorder (SAD) occurs in anticipation of a social event (pre-event rumination) and in its aftermath (post-event rumination). Both are proposed to be key maintaining factors of the vicious cycle of social anxiety. Despite this, there is a dearth of research investigating the processes that mediate the relationship between social anxiety and pre-event rumination and uncertainty regarding the cognitive and attentional processes that mediate the relationship between social anxiety and post-event rumination. To investigate this further, the current study utilised a clinical sample of participants with SAD to determine the hypothesised mediators of a social anxiety and pre-event model (N = 239) and a social anxiety and post-event rumination model (N = 216). Results from path analyses were broadly consistent with cognitive models of SAD that posit several interrelated processes mediate the relationship between social anxiety and pre- and post-event rumination. Results also indicated slightly different processes showed stronger prediction of pre-event rumination (i.e., biased performance appraisals) and post-event rumination (i.e., negative attentional focus). Treatment recommendations that aim to address the maladaptive role of negative rumination in social anxiety are made in keeping with the inter-connected and dynamic role played by cognitive and attentional processes in heightening social anxiety.

A framework to create more mentally healthy workplaces: A viewpoint.

Mental illness is now the leading cause of long-term sickness absence among Australian workers, with significant costs to the individual, their employers and society more broadly. However, to date, there has been little evidence-informed guidance as to what workplaces should be doing to enhance their employees' mental health and wellbeing. In this article, we present a framework outlining the key strategies employers can implement to create more mentally healthy workplaces. The five key strategies outlined are as follows: (1) designing work to minimise harm, (2) building organisational resilience through good management, (3) enhancing personal resilience, (4) promoting early help-seeking and (5) supporting recovery and return to work. A narrative review is utilised to outline the theoretical evidence for this framework and to describe the available research evidence for a number of key example interventions for each of the five strategies. While each workplace needs to develop tailored solutions, the five strategy framework proposed in this review will hopefully provide a simple framework for employers and those advising them to use when judging the adequacy of existing services and considering opportunities for further enhancements.

Multimorbidity and depression: A systematic review and meta-analysis.

BACKGROUND: Multimorbidity, the presence of two or more chronic conditions, is increasingly common and complicates the assessment and management of depression. The aim was to investigate the relationship between multimorbidity and depression. METHOD: A systematic literature search was conducted using the databases; PsychINFO, Medline, Embase, CINAHL and Cochrane Central. Results were meta-analysed to determine risk for a depressive disorder or depressive symptoms in people with multimorbidity. RESULTS: Forty articles were identified as eligible (n = 381527). The risk for depressive disorder was twice as great for people with multimorbidity compared to those without multimorbidity [RR: 2.13 (95% CI 1.62-2.80) p<0.001] and three times greater for people with multimorbidity compared to those without any chronic physical condition [RR: 2.97 (95% CI 2.06-4.27) p<0.001]. There was a 45% greater odds of having a depressive disorder with each additional chronic condition compared to the odds of having a depressive disorder with no chronic physical condition [OR: 1.45 (95% CI 1.28-1.64) p<0.001]. A significant but weak association was found between the number of chronic conditions and depressive symptoms [r = 0.26 (95% CI 0.18-0.33) p <0.001]. LIMITATIONS: Although valid measures of depression were used in these studies, the majority assessed the presence or absence of multimorbidity by self-report measures. CONCLUSIONS: Depression is two to three times more likely in people with multimorbidity compared to people without multimorbidity or those who have no chronic physical condition. Greater knowledge of this risk supports identification and management of depression.

Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems.

It has been suggested that certain types of work may increase the risk of common mental disorders, but the exact nature of the relationship has been contentious. The aim of this paper is to conduct the first comprehensive systematic meta-review of the evidence linking work to the development of common mental health problems, specifically depression, anxiety and/or work-related stress and to consider how the risk factors identified may relate to each other. MEDLINE, PsychInfo, Embase, the Cochrane Collaboration and grey literature databases were systematically searched for review articles that examined work-based risk factors for common mental health problems. All included reviews were subjected to a quality appraisal. 37 review studies were identified, of which 7 were at least moderate quality. 3 broad categories of work-related factors were identified to explain how work may contribute to the development of depression and/or anxiety: imbalanced job design, occupational uncertainty and lack of value and respect in the workplace. Within these broad categories, there was moderate level evidence from multiple prospective studies that high job demands, low job control, high effort-reward imbalance, low relational justice, low procedural justice, role stress, bullying and low social support in the workplace are associated with a greater risk of developing common mental health problems. While methodological limitations continue to preclude more definitive statements on causation between work and mental disorders, there is now a range of promising targets for individual and organisational-level interventions aimed at minimising mental health problems in the workplace.

Negative rumination in social anxiety: A randomised trial investigating the effects of a brief intervention on cognitive processes before, during and after a social situation.

BACKGROUND AND OBJECTIVES: According to cognitive models of Social Anxiety Disorder (SAD), negative rumination is a key maintaining factor in the vicious cycle of social anxiety. However, there is a scarcity of research investigating treatment effects on rumination in social anxiety, as well as other key cognitive variables. The current study aimed to determine the effectiveness of a brief intervention on a range of cognitive processes, most notably negative rumination. Additionally, predictors of negative rumination and state anxiety are also investigated. METHODS: Participants with a diagnosis of SAD were randomly allocated to an intervention (n = 24) or control group (n = 23). Participant's initially completed trait and state based measures with the intervention group also completing a brief cognitive intervention. One-week later participants completed state anxiety and cognitive measures before and after a speech task. Finally, one-week post-speech task participants completed further trait and state based measures. RESULTS: While the brief cognitive intervention had positive effects on some of the cognitive processes measured at different time points of the study, levels of negative rumination remained stable. Predictors of negative rumination and state anxiety were consistent with cognitive models of SAD. LIMITATIONS: The brief nature of the intervention and temporal stance of the intervention (delivered one-week before the speech) may have impacted outcomes. CONCLUSIONS: Cognitive technique can potentially impact a range of key processes that maintain SAD, however, more powerful and tailored interventions are needed that address the different processes at play before, during and after a social situation for socially anxious individuals.

Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence.

BACKGROUND: Individual placement and support (IPS) is a vocational rehabilitation programme that was developed in the USA to improve employment outcomes for people with severe mental illness. Its ability to be generalised to other countries and its effectiveness in varying economic conditions remains to be ascertained. AIMS: To investigate whether IPS is effective across international settings and in different economic conditions. METHOD: A systematic review and meta-analysis of randomised controlled trials comparing IPS with traditional vocational services was undertaken; 17 studies, as well as 2 follow-up studies, were included. Meta-regressions were carried out to examine whether IPS effectiveness varied according to geographic location, unemployment rates or gross domestic product (GDP) growth. RESULTS: The overall pooled risk ratio for competitive employment using IPS compared with traditional vocational rehabilitation was 2.40 (95% CI 1.99-2.90). Meta-regressions indicated that neither geographic area nor unemployment rates affected the overall effectiveness of IPS. Even when a country's GDP growth was less than 2% IPS was significantly more effective than traditional vocational training, and its benefits remained evident over 2 years. CONCLUSIONS: Individual placement and support is an effective intervention across a variety of settings and economic conditions and is more than twice as likely to lead to competitive employment when compared with traditional vocational rehabilitation.

The mental health benefits of employment: Results of a systematic meta-review.

OBJECTIVE: The literature on mental health in the workplace largely focuses on the negative impacts of work and how work may contribute to the development of mental disorders. The potential mental health benefits of employment have received less attention. METHOD: A systematic search of reviews or meta-analyses that consider the benefits of work in regards to mental health was undertaken using academic databases. All relevant reviews were subjected to a quality appraisal. RESULTS: Eleven reviews were identified as meeting the inclusion criteria, with four deemed to be of at least moderate quality. The available evidence supports the proposition that work can be beneficial for an employee's well-being, particularly if good-quality supervision is present and there are favourable workplace conditions. The benefits of work are most apparent when compared with the well-documented detrimental mental health effects of unemployment. CONCLUSIONS: The potential positive effects of good work and the role work can play in facilitating recovery from an illness and enhancing mental well-being need to be highlighted and promoted more widely. Future research should aim to further investigate what constitutes a 'good' workplace or a 'good' job in terms of mental health outcomes.

Psychometric evaluation of self-report measures of binge-eating symptoms and related psychopathology: A systematic review of the literature.

OBJECTIVE: Binge eating is a symptom common to bulimia nervosa, anorexia nervosa (binge/purge subtype), and binge eating disorder. There are many self-report measures available to aid the assessment of eating disorders symptoms, but there has not yet been a systematic review of the literature to identify the most valid and reliable measures for use in assessment and treatment of binge eating. METHOD: A systematic review of the psychometric properties of self-report measures that assess binge eating symptoms and psychopathology was conducted. Two independent raters assessed the psychometric properties of each measure using a standardized quality analysis tool. RESULTS: Of the 2,927 studies identified, 72 studies met the inclusion criteria and described the psychometric properties of 29 different self-report measures, and nine specific subscales within these. Results from the quality analysis tool utilized in this study indicated that none of the included measures currently meet all nine criteria of adequate psychometric properties. DISCUSSION: Most of the included measures had evidence for some adequate psychometric properties. Two measures received six out of nine positive ratings for the assessed psychometric properties, the BITE and the BULIT-R, and thus appear to be the measures with the most evidence of their validity and reliability. Overall, our findings implicate a need for further investigation of the psychometric properties of the available self-report questionnaires in this field.

Preventing the development of depression at work: a systematic review and meta-analysis of universal interventions in the workplace.

BACKGROUND: Depression is a major public health problem among working-age adults. The workplace is potentially an important location for interventions aimed at preventing the development of depression, but to date, the mental health impact of universal interventions in the workplace has been unclear. METHOD: A systematic search was conducted in relevant databases to identify randomized controlled trials of workplace interventions aimed at universal prevention of depression. The quality of studies was assessed using the Downs and Black checklist. A meta-analysis was performed using results from studies of adequate methodological quality, with pooled effect size estimates obtained from a random effects model. RESULTS: Nine workplace-based randomized controlled trials (RCT) were identified. The majority of the included studies utilized cognitive behavioral therapy (CBT) techniques. The overall standardized mean difference (SMD) between the intervention and control groups was 0.16 (95% confidence interval (CI): 0.07, 0.24, P = 0.0002), indicating a small positive effect. A separate analysis using only CBT-based interventions yielded a SMD of 0.12 (95% CI: -0.01, 0.24, P = 0.07). [corrected]. CONCLUSIONS: There is good quality evidence that universally delivered workplace mental health interventions can reduce the level of depression symptoms among workers. There is more evidence for the effectiveness of CBT-based programs than other interventions. Evidence-based workplace interventions should be a key component of efforts to prevent the development of depression among adults.