Patients who come back: Clinical characteristics and service outcome for patients re‐referred to an IAPT service

Aims: Patients who are referred more than once to a Primary Care Mental Health Improving Access to Psychological Therapies (IAPT) Service raise questions about those patients' clinical characteristics, the appropriateness of the interventions offered and their capacity to make use of them. IAPT treatments are based on National Institute for Health and Clinical Excellence (NICE) guidelines for the treatment of common mental health problems. NICE recommendations are based on evidence gained from clinical trials, in particular Randomised Controlled Trials (RCTs), which tend to exclude the sort of patient with complex and co‐morbid conditions who often present in practice. Method: Using data routinely collected from the IAPTus clinical database, re‐referral patterns and level of complexity of 50 patients who were referred on more than one occasion to a Primary Care Mental Health (Improving Access to Psychological Therapies) Team from 2009–2010, were analysed. Results: The evidence presented in this study indicates patients who re‐refer exhibit complex environmental, historical and psychological problems. Implications for practice: Although further research is required to compare the characteristics of this patient group with those who are referred only once, this study provides limited evidence that such patients may be more likely to engage and complete treatments that offer regular, structured and one‐to‐one interventions.     

The Effect of Racial and Ethnic Diversity on the Delivery of Mental Health Services in Pediatric Primary Care

The effects of racial and ethnic diversity on the detection and management of behavioral and emotional problems in pediatric primary care are addressed. Service access and utilization as a function of race and culture are initially examined. Important barriers within pediatric training including minimal emphases on behavioral training and the limited supply of minority physicians are underscored. The impact of ethnicity on the development and maintenance of the clinical relationship that is critical to accurately and sensitively identifying and managing behavioral and developmental problems is briefly addressed. Recommendations for further integration of racial/ethnic issues into mental health service provision within the pediatric primary care arena are presented.     

Who drops-out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?

Aims: Unplanned endings, where clients unilaterally end therapy, are of concern for psychological therapy services generally as they raise questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop-out often have more severe symptoms at entry, and have poorer clinical outcomes. This raises further questions about risk to self and others for those clients who leave therapy prematurely and how these clients might be identified and kept engaged. Method: This paper uses a large dataset of CORE data collected routinely in a primary care counselling service between 2000 and 2003. Logistic regression was utilised to consider different measures of risk and other client characteristics recorded at assessment to predict drop-out from the service. Results: These indicate that younger age, greater psychological distress at assessment, an addiction problem and greater risk to others, are associated with an unplanned ending. However, no reliable logistic regression model could be produced. This may be partly due to data quality issues or important characteristics not being available in the data. Implications for practice: The paper concludes that counsellors should actively seek to minimise unplanned endings, as amongst them may be represented the more distressed and risky clients referred to primary care counselling.     

Primary Prevention Mental Health Programs: The Future is Exciting

Current outcome research on primary prevention mental health programs is encouraging and the future is exciting. Data continue to accumulate regarding the efficacy of preventive intervention. Exemplary programs can prevent multiple problems across different outcome domains suggesting the need for collaboration among preventionists across disciplines and research areas. The commentators on our review (Durlak and Wells, 1997) offered many useful suggestions to improve the next generation of research. Most recommendations fall broadly under the rubric of increasing the precision of theory, design, and program evaluation. If current recommendations for improving future research are followed, the next reviewers of primary prevention mental health programs for children and adolescents will have a more complete and useful database for analysis.     

Extended problem solving treatment for depression

Introduction: Effective brief psychological approaches for depression that can be delivered by a variety of health professionals with minimal training increase access to treatment by patients. Problem Solving Treatment (PST) was developed for primary care and was modified for this study (EPST) to better meet the needs of mental health patients. Method: A total of 92 therapists from different professional backgrounds completed EPST workshops and treated 92 patients with major depression with interval clinical and treatment process assessments. Results: EPST achieved a significant reduction in depressive symptom scores, life problem scores, and there were few treatment non‐completers. Treatment outcome was predicted by process and therapist variables. Discussion: EPST is an effective and easy to teach treatment that can be delivered by a variety of practitioners and suitable for busy primary mental health care settings.     

Primary Prevention Mental Health Programs for Children and Adolescents: A Meta-Analytic Review

Used meta-analysis to review 177 primary prevention programs designed to prevent behavioral and social problems in children and adolescents. Findings provide empirical support for further research and practice in primary prevention. Most categories of programs produced outcomes similar to or higher in magnitude than those obtained by many other established preventive and treatment interventions in the social sciences and medicine. Programs modifying the school environment, individually focused mental health promotion efforts, and attempts to help children negotiate stressful transitions yield significant mean effects ranging from 0.24 to 0.93. In practical terms, the average participant in a primary prevention program surpasses the performance of between 59% to 82% of those in a control group, and outcomes reflect an 8% to 46% difference in success rates favoring prevention groups. Most categories of programs had the dual benefit of significantly reducing problems and significantly increasing competencies. Priorities for future research include clearer specification of intervention procedures and program goals, assessment of program implementation, more follow-up studies, and determining how characteristics of the intervention and participants relate to different outcomes.     

Attention-Deficit Hyperactivity Disorder: The Medicalization of Misbehavior

During the past decade, there has been an increase in the diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD). This syndrome, typically diagnosed in childhood, is characterized by inattention, hyperactive motor behavior, and distractibility. Current prevalence rates obtained in various countries generally exceed the 3–5% reported by DSM-IV. Reasons for increased ADHD prevalence include changes in diagnostic standards, overlap between ADHD and other externalizing disorders, nonspecific behavioral criteria, and the rapid effects of stimulant medication on cognitive functioning. However, social, cultural, and economic factors may also contribute to increased diagnosis. ADHD has become a common topic in the lay media. Popular discussions of ADHD may serve as a metaphoric expression of social anxieties, particularly with respect to children. At the same time, ADHD has rapidly become incorporated into a medical model, with emphasis on pharmacological treatment. Reductions in mental health and educational services, as well as economic pressures of managed care, may also contribute to medicalization of behavioral problems. Collaboration between psychologists and primary care physicians can lead to more accurate diagnosis and appropriate treatment of ADHD and related disorders.     

“Hello,can you hear me?”: Narratives of online mental health counselling among Filipino adults during the pandemic

Filipinos are often reluctant to seek professional mental health (MH) help. However, literature reveals that online counselling is preferable to face-to-face (F2F) MH services, with the pandemic possibly magnifying technology's anonymity and disinhibiting benefits. To further explore facilitators of online MH help-seeking, this study tapped into the lived stories of Filipino adults who experienced at least one counselling session from March 2020 to March 2022. Among 83 screened respondents, 11 semistructured interviews were transcribed and analysed following Crossley's (2000) method. Findings reveal an overarching online MH counselling narrative composed of three phases and their respective events: (a) Precounselling (Resiliency Narrative versus MH Awareness, Turning Point, and Linking versus Searching); (b) Counselling (Two-way Introduction, Unloading and Untangling, and Decision to Maintain or Terminate); and (c) Postcounselling (Relapse and Journey towards Growth and Advocacy). Three all-encompassing facilitators were embedded throughout the process: Autonomy, Financial Capability, and MH Institutions. Notably, participants attributed their MH help-seeking to autonomy, despite culture and stigma, because of enabling environments that entail heightened MH literacy, positive past experiences with professional MH help, social support and encouragement, and a sense of shared reality. Benefits unique to online counselling were also apparent among participants' narratives, including alleviating geographical boundaries and added financial and personal pressures. Overall, findings posit that Filipino adults consider online counselling as a preferable alternative to F2F counselling, thus necessitating further development and institutional support.     

Predictors of university students’ willingness in the USA to use clergy as sources of skilled help

This exploratory study investigated U.S. university students’ perceptions (N = 186) and the predictor variables associated with their willingness to use clergy as a source of help. In the final regression analysis using the predicted variable of willingness to use clergy as a source of help (R = 0.816, R ²= 0.665, Adjusted R ²= 0.650), there were seven significant predictor variables: (a) trust of clergy, (b) empathic ability of clergy, (c) having previously sought help from clergy, (d) respondents’ dominant/minority cultural identification, (e) attendance at religious services at least once a year, (f) believing that spiritual counselling is as effective as psychotherapy, and (g) receiving religious/spiritual education as a child. An eighth variable was retained in the final regression model because of its proximity to significance (Friendships between clergy and people, p = 0.051). Accusations against clergy and the belief that clergy are held to a higher standard did not predict willingness to use clergy as a source of help. A general linear model (F = 125.696, df = 10, p < 0.001) revealed that those who self-identified with Protestant Christianity, Catholic/Orthodox Christianity, and Judaism were more likely to consider seeking help from clergy than those who self-identified with another religious tradition (Hinduism, Islam, or Buddhism), or adherence to spiritual not religious belief. Further, those who self-identified as Jewish or Christian were also more like to perceive clergy as trustworthy and empathic. Finally, African American/Caribbean Black respondents were more likely than either Latino/Latino American respondents or European American respondents to seek help from clergy, to perceive clergy as empathic, and to believe that spiritual counselling is as effective as psychotherapy (F = 1495, df = 12, p < 0.001).     

Pilot Effectiveness of a Stress Management Program for Sheltered Homeless Adults With Mental Illness: A Two-Group Controlled Study

This study examined the effectiveness of a stress management intervention for sheltered homeless adults with mental illness. Twelve intervention participants received a 6-week, 1-hour psychoeducation group combined with a 20-minute meditation. Eleven matched pairs did not receive intervention and served as controls. At 1 week post study, intervention participants reported a statistically significant reduction in perceived stress (Z=??2.285, p < .02, d=??1.176) compared to controls. No differences were found at 1 week post study between intervention and control participants on reported quality of life. This study provides pilot data on the effectiveness of an occupation-based stress management program for sheltered homeless adults and warrants further study.     

Effects of order of presentation on conditional reasoning

ABSTRACT

The main goal of this research is to study whether or not the order of presentation of the premises in a logical argument form, such as a conditional reasoning task, could affect the processing time of premises and conclusion and the conclusions that participants accept as valid in an evaluation task. One experiment is reported in which participants are asked to evaluate computer-presented conditionals. Half of the problems were presented in traditional order (“if p then q, p, therefore q”) and half in inverse order (“p, if p then q, therefore q”). The experiment showed that there was an order effect in processing the premises and conclusion: participants took longer to read the premises in traditional order than in inverse order, but they took longer to read the conclusion in inverse order than in traditional order. The finding is discussed with respect to the main theories of conditional reasoning.     

Exploring rates of transgender individuals and mental health concerns in an online sample

Background: Prevalence estimates of adults identifying as transgender are scarce, particularly in the United States. Method: The current study endeavored to estimate the prevalence of individuals identifying as transgender in a large online sample of adult U.S. residents (n = 6,727) and compare the prevalence of common mental health disorders (depression, anxiety, attention-deficit/hyperactivity disorder) and the age of onset for individuals identifying as men or women versus those identifying as transgender. Results: The prevalence estimate of individuals identifying as transgender was 0.8%. Individuals identifying as transgender were significantly more likely than individuals identifying as men or women to report having had a single diagnosis or co-occurring diagnoses for all three disorders examined. Additionally, transgender individuals were more likely than individuals identifying as men or women to receive a diagnosis of anxiety or depression at a younger age. Conclusion: Given the prevalence of transgender individuals and the associations with common mental health conditions, clinicians must be informed and competent to care for their clinical needs. This study introduces online crowdsourcing resources as a potentially fruitful option for reaching and researching gender diversity.     

Relational spirituality and depression among married couples in Antigua

The World Health Organization indicates depression is the leading cause of disability worldwide. At the same time researchers have found religion/spirituality is inversely associated with depression. However, the mechanisms by which spirituality/religion impacts mental health have not been clearly identified particularly in non-western populations. Relational spirituality is a concept that focuses attention on the ways people relate to the sacred. This study examines whether different ways of relating to the sacred are implicated in levels of depression and whether marital partners affect each other’s level of relational spirituality and depression. Ninety-one (n?=?91) married heterosexual couples in the Caribbean Island of Antigua completed measures of relational spirituality and depression. Data were analysed using path analysis and through Actor Partner Interdependence Model methods. Results of the analysis showed wives’ and husbands’ depression scores covaried (COV?=?6.59, Pearson r?=?.28, p?β?=??.24, unstandardised B?=??3.23, se?=?1.30), and higher instability scores (β?=?.49, unstandardised B?=?5.46, se?=?.96). The husbands’ disappointment (β?=?.21, unstandardised B?=?2.17, se?=?.95) and instability (β?=?.54, unstandardised B?=?4.65, se?=?.72) were positively related to their depression scores. The results demonstrate relational spirituality is a useful framework for addressing depression in individuals as well as married couples.     

Where Have All the Children Gone? Movement from Child to Adult Mental Health Systems

The mental health histories of the 448 children 15 and 16 years of age who were admitted to state-operated children's psychiatric inpatient services in New York during 1982 were reviewed for the 11 year period through April 1993, Thirty-three percent were served as adults (after age 18) in the state-operated adult civil mental health system; 42% of these individuals were still receiving services at the end of the period. 113 of the 146 individuals served as adults were served only in the civil system. Thirteen percent of the cohort received some of their mental health services as adults in the state-operated adult forensic mental health system due to criminal law involvement. This includes nine percent who received mental health services while they were inmates in state prisons. Twenty four of the 57 forensic clients received services as adults only in the forensic system. Diagnostic, demographic, and service history characteristics of the groups were compared to foster an early understanding of policy and programmatic issues related to movement from the child mental health system to the adult system. Baseline (1982) information was used to identify predictors of later service utilization.     

Highlighting the Way Forward: A Review of Community Mental Health Research and Practice Published in AJCP and JCP

Articles published in the two most prominent journals of community psychology in North America, the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP), provide a clear indicator of trends in community research and practice. An examination of community psychology's history and scholarship suggests that the field has reduced its emphasis on promoting mental health, well‐being, and liberation of individuals with serious mental illnesses over the past several decades. To further investigate this claim, the current review presents an analysis of articles relevant to community mental health (N = 307) published in the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP) from 1973 to 2015. The review focuses on article characteristics (e.g., type of article and methods employed), author characteristics, topic areas, and theoretical frameworks. Results document a downward trend in published articles from the mid‐1980s to mid‐2000s, with a substantial increase in published work between 2006 and 2015. A majority of articles were empirical and employed quantitative methods. The most frequent topic area was community mental health centers and services (n = 49), but the past three decades demonstrate a clear shift away from mental health service provision to address pressing social issues that impact community mental health, particularly homelessness (n = 42) and community integration of adults with serious mental illnesses (n = 40). Findings reflect both the past and present state of community psychology and suggest promising directions for re‐engaging with community mental health and fostering well‐being, inclusion, and liberation of adults experiencing serious mental health challenges.     

Quantification of Electroencephalography

In Experiment 1, a study by Messer was replicated with use of 18 children aged 40 to 67 months and nonsense words in which the phonemes of the consonant onsets of permissible and impermissible words were equated for frequency of occurrence. The children did not choose significantly more permissible words at any age, indicating that they did not use phonological rules as a basis for choice. In Experiment 2, similar materials were used with 14 children aged 56 to 74 months. By means of an operant conditioning procedure and a learning set paradigm, an experimental group (five children) was reinforced for choosing the permissible member of 10 permissible/impermissible pairs of nonsense words to a criterion of 80 percent correct responses. On transfer to a test task (16 problems given at a rate of 12 trials per problem) the group reached a mean performance level of 76 percent correct responses, which was significantly greater than that attained by either of two control groups (nine children). It was therefore concluded that some evidence for the existence of implicit phonological rules had been obtained, although the conclusion had to be qualified because (a) the mean level of performance of the experimental group during the test task was relatively low, and (b) because only children with high 1Qs performed at a level better than chance.     

The buffering role of social support on the associations among discrimination,mental health,and suicidality in a transgender sample

Introduction: Per the minority stress framework, trans individuals often experience psychological distress given the unique stress engendered by gender identity–related discrimination. Prior research has identified social support as particularly important for psychological distress and has suggested that social support may moderate this relationship. The purpose of the current study was to explore the patterns of connections among discrimination, mental health, and suicidal ideation in trans individuals and whether social support moderates these relationships. Methods: Participants (N = 78) completed measures of these constructs as part of a national online survey. Results: A series of simultaneous multiple regressions found that harassment/rejection discrimination was a unique positive predictor of mental health symptoms and suicidal ideation, with depression positively predicting suicidal ideation. A mediational model indicated that the association between harassment/rejection discrimination and suicidal ideation was fully mediated by depression. Three moderated meditational models were run, and one yielded a significant interaction, such that discrimination predicted suicidal ideation most strongly when participants had low social support from a significant other in comparison to participants who had moderate or high support. Further, conditional direct effects identified that discrimination led to ideation only for individuals with low support from friends or a significant other but not for those with moderate or high support. Conclusions: Helping trans individuals cope with harassment and rejection, particularly by drawing on social support, may promote better mental health, which could help reduce suicidality in this population.     

Children's understanding of embarrassment: Integrating mental time travel and mental state information

The current study investigated 4‐ to 8‐year‐olds’ (N = 81) understanding of embarrassment and their ability to integrate temporal and mental state information to predict and explain emotions. Participants heard stories describing characters commit trivial social transgressions, and then the next day, characters found themselves in the same situation that led to the previous transgression. For some story endings, participants were asked to predict and explain how the character felt, and for others, participants were told the character started to feel embarrassed and they were asked to explain why. Participants’ responses were coded and analysed using nonparametric statistical tests. Kruskal–Wallis analyses revealed significant developments occur between 6 and 8 years in children's understanding of embarrassment and their ability to explain individual's emotion as caused by anticipating the reoccurrence of a previous embarrassing event. Younger children demonstrated a basic knowledge of embarrassment but failed to demonstrate more advanced understanding of the emotion. Findings from the current study indicate children reach a more mature understanding of embarrassment and the implications of committing social transgressions between 7 and 8 years. Finally, the current study contributes to the literature on children's ability to infer mental states and temporally connect experiences.