Early findings of a nurse-led youth activist program in mind caring.

BACKGROUND: School-based youth activist programs in mind caring have been shown to support the mental health and learning needs of adolescent students. METHODS: We used collaborative action research methods to implement a nurse-led mind caring youth activist program for a rural, extended opportunity school in Thailand. The participants (N = 67) were the public health nurse assigned to the school, students willing to become youth activists (n = 42), school teachers and staff (n = 7), university psychiatric mental health nursing faculty (n = 2), and volunteer nursing students (n = 16). Qualitative thematic analyses methods were used to explore the transcripts of the participant's reflection circles and confirmatory interviews for evidence of effective program implementation. RESULTS: Major themes of change and growth were identified. Youth activists students said mind caring improved their mental health. Teachers described having a more positive attitude towards students' mental health and learning needs. Nursing students found optimistic confidence and self-awareness in the hands-on experience with the complex role responsibilities in public health nursing. CONCLUSION: These results provide early evidence of stakeholder satisfaction with the implementation of a school-based youth activist program as collaborative action for organizational change.

Critical Environmental Justice Nursing for Planetary Health: A Guiding Framework.

Personal and planetary environmental justice has become a driving force for innovation in nursing science. The purpose of our Critical Environmental Justice Nursing for Planetary Health Framework is to guide this work by applying critical theory to the way we conceptualize the root causes of environmental injustices. The framework calls for more ethical responses to injustices and challenges the biohierarchical belief that nonmales, non-Whites, and nonhumans are lesser beings that can be made profitable. This response requires nurse leaders who are well prepared in the science and practice of planetary health and the ontologies and epistemologies of regeneration and transformation.

Meta-Analysis of Cultural Influences in Trauma Exposure and PTSD Prevalence Rates.

INTRODUCTION: The global prevalence of posttraumatic stress disorder (PTSD) continues to rise, the influence of culture and resilience remains unclear. This review and meta-analysis aimed to (a) examine the prevalence of PTSD among studies addressing culture and resilience, and (b) compare the PTSD prevalence rates across different trauma exposures and cultural contexts. METHODOLOGY: PubMed, CINAHL, and PsycINFO were searched for articles published between 01/01/2000 to 12/01/019 that defined PTSD, reported PTSD prevalence rates, and addressed culture and resilience. Meta-analysis of PTSD prevalence rates was performed using generalized linear mixed models. RESULTS: Thirty articles met all search criteria. In the pooled sample of 20,138 participants, 3,403 met defined PTSD diagnostic criteria. The random-effects model showed PTSD cultural effects. Refugees displaced in similar cultures (0.44) had higher rates of PTSD. DISCUSSION: Findings indicate that trauma-informed, practical assessments of health protective cultural determinants may promote individual resilience and reduce the risk of PTSD in displaced refugees.

Traumatic Brain Injury Screening and the Unmet Health Needs of Shelter-Seeking Women with Head Injuries Related to Intimate Partner Violence.

Background: Unmet health needs of women with head injuries sustained by intimate partner violence (IPV) include risk of traumatic brain injury (TBI). The purpose of this evaluation was to explore the potential effectiveness of TBI screening as a health promotion strategy for shelter-seeking women with IPV head injuries. We wanted to learn if shelter-seeking women, willing to disclose IPV, would accept TBI screening if offered. Methods: An extended version of the HELPS TBI screening tool and survey of daily symptoms and health needs were used to screen new residents of an urban shelter for women. Results: The participants (N = 18) primarily were educated black women with one or more self-reported IPV-related head injury. Most participants (77.8%) had positive TBI screens for probable brain injury. The majority (88.8%) lived with one or more daily symptoms they did not have before sustaining a IPV head injury. The symptoms reported most frequently were depression (88.9%), anxiety (77.8%), and headache (66.7%). All participants had one or more unmet health need. Although most (77.8%) needed to see a primary care provider, mental health care was the most important health need identified. Conclusions: TBI screening could be considered an effective health promotion strategy for IPV survivors if screening facilitates treatment for positive screens and other unmet health needs. Further research is needed to properly assess this.

Properties of the Early Symptom Measurement of Post-Stroke Depression: Concurrent Criterion Validity and Cutoff Scores.

BACKGROUND: Early-stage post-stroke depression (PSD) increases the risk of stroke-related disability and mortality in the first year of recovery. Presently available screening measures were developed to assess major depression, and none used a PSD screening criterion that was systematically developed and tested in populations of patients with acute stroke. PURPOSE: The purpose of this study was to evaluate the concurrent criterion validity and cutoff scoring of the Early Symptom Measurement of Post-Stroke Depression (ESM-PSD) instrument in hospitalized patients with acute stroke. METHODS: Purposive recruitment of newly admitted patients yielded a qualified sample of 139 nonaphasic participants who were 7-30 days post mild-to-moderate stroke confirmed by computed tomography and magnetic resonance images. Participants responded to the ESM-PSD and Hamilton Rating Scale for Depression-24 (HAMD-24). RESULTS: The mean number of post-stroke days was 11.99 (SD = 7.68). Cronbach's alpha estimates of internal consistency were ESM-PSD = .90 and HAMD-24 = .76. ESM-PSD measurement sensitivity and specificity were superior. The following three ESM-PSD cutoff scores, determined by the receiver operating characteristic curve, were used to assess clinically relevant early-symptom levels: no PSD < 14.5, low PSD = 14.5-25.5, moderate PSD = 25.5-45.5, high PSD ≥ 45.5. CONCLUSION/IMPLICATIONS FOR PRACTICE: ESM-PSD cutoff scores show the expected correspondence with mild-moderate-severe HAMD-24 symptoms, which was evidenced by the high area under the receiver operating characteristic curve. Planned follow-up research will assess the efficacy of using ESM-PSD scores to detect increased risk of major depression onset in patients with acute stroke.

Development and initial validation of a clinical measure to assess early symptoms of post-stroke depression in the acute stroke patient.

AIMS AND OBJECTIVES: To evaluate a measure specifically developed to clinically assess early symptoms of poststroke depression (PSD) in acute stroke patients. BACKGROUND: Poststroke depression is associated with elevated rates of morbidity and mortality following a mild-to-moderate stroke. Measures currently used to assess depression in acute poststroke patients can lack the clinical specificity necessary to detect symptoms within 30 days poststroke. DESIGN: A two-round Delphi design was used to estimate symptom consensus. METHODS: Three panels, healthcare professionals (N = 74), experts (N = 16) and acute poststroke patients (N = 40), evaluated an initial set of symptom-items systematically developed by the research team. RESULTS: Our study yielded consensus for 29 symptom-items. Additional symptoms recommended by acute poststroke patients increased the final number of symptoms to 35. CONCLUSIONS: We developed a specific measure of early symptoms of PSD in acute stroke patients with good content validity. RELEVANCE TO CLINICAL PRACTICE: The specific clinical relevance of our findings lies in the consensus of health professionals, the Delphi panel and patients regarding core areas of clinical assessment during the acute poststroke phase. And our findings may draw attention to the need to assess and treat acute stroke patients with early symptoms of PSD.

Early symptom measurement of Post-Stroke Depression (PSD).

BACKGROUND: We reported the factor structure and psychometric properties of a new measure of early symptoms of Post-Stroke Depression (PSD). METHODS: Cross-sectional survey methods were used to administer the measure to hospitalized post-stroke patients (N=410) in southeast China, 7-30 days after mild to moderate stroke. Factor structure of the measure was evaluated using exploratory factor analysis (EFA) with first and second order confirmatory factor analysis (CFA). Measurement reliability of each factor and the total measure was assessed using Cronbach alpha coefficient, item-total correlation, item-subscale correlation and the composite coefficient. Discriminant validity was tested using the estimated correlation matrix and average variance extracted (AVE). RESULTS: The EFA extracted a theoretically consistent, clinically interpretable, 29-item, 6-factor model for early symptoms of PSD (dull, guilt, low, wakefulness, emotional, and nervous). A first order CFA retained the 6-factors but deleted 3 underperforming items. The results of a second-order CFA for a 6-factor, 26-item model showed acceptable model fit (χ(2)/df=2.25, CFI=0.973, TLI=0.970, RMSEA=0.055 and WRMR=1.168) with acceptable reliability and discriminant validity. LIMITATIONS: The study survey methods and purposive sampling procedures resulted in a clinically less homogenous final sample. Separate evaluation of predictive validity, criteria validity, test-retest reliability, and invariance to patient psychosocial characteristics of the measure is planned. CONCLUSIONS: Our measure detected early symptoms of PSD in primarily first-ever stroke patients, an average of 11.07 days post stroke, well within the 14 day peak benchmark.

Stigma Related Avoidance in People Living with Severe Mental Illness (SMI): Findings of an Integrative Review.

The purpose of this integrative review is to synthesize primary evidence of the impact of internalized stigma on avoidance in adult community treatment patients living with SMI. A keyword database search of articles published through 2015 yielded 21 papers and a total of 4256 patients. Our analyses found that stigmatizing beliefs associated with avoidance are related to significant loss of self-esteem. Factors generally thought to reduce stigma internalized as self-stigmatizing beliefs, such as improved insight, increased self-awareness, and psycho-education to improve stigma coping skills, do not appear to improve self-esteem.

The self-stigma of depression for women.

BACKGROUND: Self-stigmatizing women who avoid seeking treatment for depression could believe that they have pragmatic personal reasons for their decision. As a preliminary step towards testing this hypothesis, the aim of this study was to assess diverse, low-income working women for shared self-stigmatizing beliefs about depression. METHODS: Depression and depression self-stigma were assessed in a targeted sample of African American, Caucasian and Latina women who qualify for public health services and have access to health care services. RESULTS: Depression and self-stigmatizing beliefs about depression were positively correlated (r = .30-.64). Over one third of the women in the study (37.5%) said they would do what they could to keep their depression secret. Over half (55%) indicated that the person they normally would disclose depression to is their best friend. A majority (80%) of the women in the study said they would choose not to disclose personal depression to a health care professional. Pairwise t tests for group differences showed that Caucasian women, women recently seen by a health care professional and women with more years of education had higher self-stigma scores. CONCLUSION: Self-stigmatizing women who feel depressed could knowingly decide to keep their depression secret with the hope of avoiding loss.

Successful holistic management of type 2 diabetes with depression: a very personal story.

We used illness narrative methods to evaluate the retrospective illness story of a bereaved woman who has recovered from type 2 diabetes and depression with comorbid hypertension, hyperlipidemia, vertigo, and obesity. Her spoken illness story was obtained with a single interview question: What happened? Our findings show that the patient searched for and found personal meaning in her illness. The finding of meaning in her illness appears to have supported her efforts to adopt more positive health beliefs and health behaviors. Although she received excellent health care throughout her illness, she attributes her return to good health to spiritual growth. We discuss the practice implications of this patient's illness story for clinicians who seek new insights into patients who have complex illness stories.

What comprises clinical experience in recognizing depression?: the primary care clinician's perspective.

PURPOSE: Depression is a highly prevalent condition in primary care settings. In our previously reported work, we investigated the processes and conditions that influence primary care clinicians' recognition of depression. Three conditions influence the recognition of depression: familiarity with the patient, time available, and clinical experience. This article further describes the role of clinical experience in depression care. METHODS: The grounded theory method was used to guide data collection and analysis. In-depth, in-person interviews were conducted with a purposeful sample of 8 clinicians. All interviews were audiotaped and transcribed. RESULTS: We identified 3 areas that comprise clinical experience relevant to depression care: (1) knowing one's professional role, (2) knowing oneself, and (3) knowing one's patients. In knowing one's professional role, 4 subdimensions were identified: (1) becoming familiar with illness patterns and clinical skills, (2) learning what works in the real world, (3) understanding what being a doctor is about, and (4) thinking of the whole person. The analysis indicated that clinical experience results from professional and personal growth during interactions with patients. The outcome of this developmental process was the achievement of comfort with depression care, a critical mediating variable that influenced primary care clinicians' recognition of depression. CONCLUSIONS: The developmental process of attaining comfort in managing depression warrants further exploration. Developing interventions to speed this process offers another approach to enhancing care for the management of depression.

Positive and negative depression coping in low-income African American women.

The purpose of the study was to examine positive and negative depression coping (DC) in low-income African American women. Because low-income African American women have been shown to be vulnerable to depression symptom onset yet less accepting of treatment, DC in this population is of interest to researchers. Depression symptom severity, defense mechanisms, difficult life circumstances (DLC), and social support were examined as possible determinants of DC. In 244 mildly or moderately to severely depressed women, mature defense mechanisms predicted positive DC, and DLC predicted negative DC. Social support had no effect on positive or negative DC. Findings are discussed in terms of individual and community tailored rehabilitative psychotherapy to promote positive DC.

The recognition of depression: the primary care clinician's perspective.

PURPOSE: The purpose of this study was to explore the responses of primary care clinicians to patients who complain of symptoms that might indicate depression, to examine the clinical strategies used by clinicians to recognize depression, and to identify the conditions that influence their ability to do so. METHODS: The grounded theory method was used for data collection and analysis. In-depth, in-person interviews were conducted with a purposeful sample of 8 clinicians. All interviews were audiotaped and transcribed. RESULTS: This study identified 3 processes clinicians engage in to recognize depression-ruling out, opening the door, and recognizing the person-and 3 conditions-familiarity with the patient, general clinical experience, and time availability-that influence how each of the processes is used. CONCLUSIONS: The likelihood of accurately diagnosing depression and the timeliness of the diagnosis are highly influenced by the conditions within which clinicians practice. Productivity expectations in primary care will continue to undermine the identification and treatment of depression if they fail to take into consideration the factors that influence such care.

Implications of self-administered St. John's wort for depression symptom management.

PURPOSE: To provide nurse practitioners (NPs) with a greater understanding of the complex issues surrounding St. John's wort as a self-treatment for depression; to review laws regulating the production and sale of herbal products in the United States (U.S.); and to review clinical and practice implications for the self-administration of St. John's wort and herbal treatments. DATA SOURCES: Federal regulations pertaining to herbal products, current research literature, and anecdotal and consumer reports. CONCLUSIONS: Current research findings suggest that St. John's wort may be an effective treatment for mild depression; however, evidence of significant adverse drug interactions with St. John's wort should not be overlooked. IMPLICATIONS FOR PRACTICE: Clinical assessment of the mildly depressed patient wishing to self-administer St. John's wort requires basic knowledge of this herbal supplement including regulation and risk information. An open NP-patient relationship helps to ensure patient disclosure of self-administered St. John's wort.