Building a Bridge of Trust: Collaborative Assessment With a Person With Serious Mental Illness

Collaborative assessment utilizes psychological testing to help people make positive changes in their lives. Limited research has evaluated the utility of collaborative assessment for persons with serious mental illness. This case example uses the Personality Assessment Inventory to illustrate the usefulness of collaborative assessment with a person with serious mental illness. This approach informed not only diagnostic considerations but also revealed the client's current level of distress, contributed to enhanced therapeutic alliance, and directly pointed to psychiatric rehabilitation strategies.     

Cortisol Awakening Response as an Index of Mental Health and Well-Being in Adolescents

Physiological measures provide a useful complement to self-report indices of mental health and well-being. The cortisol awakening response (CAR) has been associated with mental distress, but less consistently so with positive functioning. In this study, the utility of two CAR indices as a measure of the full spectrum of mental health and well-being in a sample of healthy adolescents was explored. Forty-seven adolescents (14M, 33F; mean age 13.89, SD = .73) completed questionnaires on mental distress and positive functioning, and provided three saliva samples for cortisol analysis as well as demographic and life event information. Correlational analyses revealed that both absolute CAR (CARi) and area under the curve during awakening (CAR_AUC) indices correlated positively with measures of mental distress, and inversely with measures of positive functioning. When the significant life events score was controlled, moderate to strong effects were maintained with negative and positive affect, mental well-being, satisfaction with life and perceived social support from significant others. These findings provide the first data confirming that CAR is a reliable index of positive functioning in healthy adolescents.     

To measure attributed mental illness1

This work follows from the assumption that person perception processes allow people to categorize others, and, thereupon, to predict the perceived person's behaviors. A scale, the Mental Illness Behaviors Prediction Scale (MIBPS) was developed for use in studies of ascribed mental illness. The MIBPS is comprised of fifteen items, each of which describes a situation and four alternative behaviors scaled for “mental illness level.” The alternatives were clearly scaleable. High item-to-total-score correlations were found. When subjects rated a “very poorly adjusted person” and a “very well-adjusted person,” the item scores, as assigned to these two persons, were clearly differentiating. In other studies the overall “mental illness level” of perceived persons was found to vary with selected independent variables. The utility of the scale supports the conclusion that people have developed and do use a person-perceiving dimension labeled mentally ill/mentally healthy, and the use of this dimension promotes the expectation of specific kinds of behavior from the target person.     

Influences on the Food Choice Behaviors of Adults With Severe Mental Illness

The objective of this research was to gain a deeper understanding of factors influencing the healthiness of food choice behaviors of community-dwelling adults with severe mental illness. Semi-structured interviews were conducted in an outpatient treatment facility with 20 program participants and 10 staff. Grounded theory analysis methods were used. Five dominant themes emerged: food availability, preference for simple food preparation, perceived cost of food, complexity of choice, and relative importance of healthy food choices. The theme of medication effects only emerged from staff interviews. This research can be useful to inform the design of nutrition interventions for this population.     

Building a bridge of trust: collaborative assessment with a person with serious mental illness

Collaborative assessment utilizes psychological testing to help people make positive changes in their lives. Limited research has evaluated the utility of collaborative assessment for persons with serious mental illness. This case example uses the Personality Assessment Inventory to illustrate the usefulness of collaborative assessment with a person with serious mental illness. This approach informed not only diagnostic considerations but also revealed the client's current level of distress, contributed to enhanced therapeutic alliance, and directly pointed to psychiatric rehabilitation strategies.     

Auditory and visual hallucinations in a sample of severely mentally ill Puerto Rican women: an examination of the cultural context

The content, interpretation, and structure of hallucinations experienced by individuals with severe mental illness are influenced by the culture of the individuals who experience them. We analyzed the content of visual and auditory hallucinations of 53 Puerto Rican women in northeastern Ohio with a diagnosis of a severe mental illness (SMI) who were participating in a study of HIV risk among Hispanic women with SMI. Compared to non-hallucinators, hallucinators had lower global assessment of functioning scores and greater suicidality. Hallucinations reflected three themes: religious themes, command hallucinations, and unidentifiable voices. Hallucinators’ subjective experience of their hallucinations ranged from a sense of security to significant distress. Participants developed a wide range of strategies to deal with threatening hallucinations. Provider response to individuals’ experience appeared to impact the quality of the patient–provider relationship. We recommend the inclusion of religious history in the initial assessment of individuals. This will assist the provider in making an accurate diagnosis, distinguishing between religious beliefs and those that reflect underlying pathology, and in increasing the level of cultural competence of the care provided. Religious and spiritual beliefs that provide a source of hope and strength for the patient can be utilized to expand and enhance the patient's coping strategies.     

Living with the unexplained: coping,distress, and depression among women with chronic fatigue syndrome and/or fibromyalgia compared to an autoimmune disorder

Chronic fatigue syndrome (CFS) and fibromyalgia are disabling conditions without objective diagnostic tests, clear-cut treatments, or established etiologies. Those with the disorders are viewed suspiciously, and claims of malingering are common, thus promoting further distress. It was hypothesized in the current study that levels of unsupportive social interactions and the coping styles used among those with CFS/fibromyalgia would be associated with perceived distress and depressive symptoms. Women with CFS/fibromyalgia (n = 39), in fact, reported higher depression scores, greater perceived distress and more frequent unsupportive relationships than healthy women (n = 55), whereas those with a chronic, but medically accepted illness comprising an autoimmune disorder (lupus erythematosus, multiple sclerosis, rheumatoid arthritis; n = 28), displayed intermediate scores. High problem-focused coping was associated with low levels of depression and perceived distress in those with an autoimmune condition. In contrast, although CFS/fibromyalgia was also accompanied by higher depression scores and higher perceived distress, this occurred irrespective of problem-focused coping. It is suggested that because the veracity of ambiguous illnesses is often questioned, this might represent a potent stressor in women with such illnesses, and even coping methods typically thought to be useful in other conditions, are not associated with diminished distress among those with CFS/fibromyalgia.     

The effects of similarity of theme and instantiation in analogical reasoning.

The influence of 2 types of structural similarity on analogical reasoning was examined. The theme of a story is a structural component that constrains other relationships in the story. Another structural component is the way in which the theme is implemented. Participants received pairs of stories that varied in the similarity of these two components. Participants in Experiment 1 judged stories containing similar themes as more analogous than stories with dissimilar themes. Likewise, stories with similar implementations were judged as more analogous than stories with dissimilar implementations. Experiment 2 revealed a similar pattern when participants had the opportunity to transfer information from source to target stories. Greater transfer was seen for stories with similar themes than for stories with dissimilar themes. Greater transfer was also seen for stories with similar implementations of different themes than for stories with different implementations.     

Mental illness has multiple causes: beliefs on causes of mental illness by congregants of selected neo-prophetic churches in Ghana

ABSTRACT

The present study explored perceived causes of, and preferred treatment approach for, mental illness among congregants of six Neo-prophetic churches in Accra and Kumasi through in-depth interviews. Using thematic analysis, five themes emerged from participants’ causal attributions of mental illness. These included lifestyles and environmental stressors, spiritual causes, interaction of multiple factors, trauma and biological causes. Additionally, participants discussed four main mechanisms through which stress leads to mental illness. These included persistent worrying over stressors, use of inappropriate coping strategies to cope with stress, refusal to talk about one's problems and individuals’ appraisal of stress and available coping resources. These beliefs directly determined congregants’ preferred treatment approach. Implications of the findings are discussed.     

Adult Missing Persons: Can an Investigative Framework be Generated Using Behavioural Themes?

There is a limited amount of research in the area of missing persons, especially adults. The aim of this research is to expand on the understanding of missing people, by examining adults' behaviours while missing and determining if distinct behavioural themes exist. Based on previous literature it was hypothesised that three behavioural themes will be present; dysfunctional, escape, and unintentional. Thirty‐six behaviours were coded from 362 missing person police reports and analysed using smallest space analysis (SSA). This produced a spatial representation of the behaviours, showing three distinct behavioural themes. Seventy percent of the adult missing person reports were classified under one dominant theme, 41% were ‘unintentional’, 18% were ‘dysfunctional’, and 11% were ‘escape’. The relationship between a missing person's dominant behavioural theme and their assigned risk level and demographic characteristics were also analysed. A significant association was found between the age, occupational status, whether they had any mental health issues, and the risk level assigned to the missing person; and their dominant behavioural theme. The findings are the first step in the development of a standardised checklist for a missing person investigation. This has implications on how practitioners prioritise missing adults, and interventions to prevent individuals from going missing. Copyright © 2016 John Wiley & Sons, Ltd.     

The Evolving Position of the American Psychiatric Association on Firearm Policy (1993–2014)

Before the Supreme Court's 2008 decision in District of Columbia v. Heller, the American Psychiatric Association's position on gun policy reflected the strong gun control perspective championed by the nation's public health establishment. After Heller declared that an individual's right to bear arms is constitutionally protected, the APA refocused its attention on the specific aspects of firearm policy that implicate the interests and rights of persons with mental illness. Psychiatrists are mindful of the need to curtail firearm access by persons with mental disorders that elevate the risk of suicide or violence to others, but they are also opposed to stigmatization, discrimination, and unfair treatment of individuals based on mental illness. Although civil commitment is an acceptable basis for prohibiting access to firearms, other adjudications of conduct indicative of elevated risk should also be included. Every state should provide a fair and reasonable process for restoring firearm rights after a suitable waiting period based on individualized assessment of whether the person remains at an elevated risk. However, restricting firearm rights of persons solely on the basis of a diagnosis of a mental disorder or voluntary treatment, whether in-patient or outpatient, discourages treatment and would be counterproductive. Copyright © 2015 John Wiley & Sons, Ltd. (original adopted by the American Psychiatric Association 2014).     

Spiritual Wellness for Clients With HIV/AIDS: Review of Counseling Issues

The epidemic of HIV/AIDS has resulted in an increasing population of individuals in need of counseling services: persons living with AIDS, as well as family, friends, and caregivers. The relationship between HIV/AIDS clients' counseling and spiritual issues is demonstrated by a review of salient literature. Three broad themes are used: terminal illness issues such as post-death existence and existential meaning of life, religious disenfranchisement from society or families of origin, and multicultural spiritual and religious issues. Practical recommendations for counselors and research implications are included.     

Illness disclosure and mental health among women with HIV/AIDS

The current study examines two contrasting models of the relationship between illness disclosure and mental health among an ethnically‐diverse group of women with HIV/AIDS. In the first, and commonly accepted model, illness disclosure predicts enhanced mental health status. In the second or alternate model, based on the stigmatization that accompanies HIV/AIDS infection, illness disclosure predicts poorer mental health. We also explore an alternate interpretation for this second model, namely that the mental health status of participants is predictive of their levels of disclosure. A total of 176 women from three major ethnic groups were interviewed and assessed during the baseline visit for a comprehensive longitudinal study. Results showed that these women constituted a highly‐disclosed population; over one‐third of them had disclosed their HIV status to their entire social networks. Contrary to expectation, disclosure was unrelated to mental health among the African‐American (n = 72) and European‐American (n = 47) women. Among the Latina women (n = 57), however, greater disclosure was related to higher levels of depression, psychological distress, and reported pain. Regression analyses controlling for age, education, and illness severity showed that disclosure makes a small but independent contribution to the prediction of mental health status. Thus, among the Latinas, the data were consistent with both the stigma model and the hypothesis that greater distress predicts wider disclosure. General patterns of disclosure are described and possible explanations for the inconsistent relationships found between disclosure and mental health among the three ethnic groups are considered. Copyright © 2000 John Wiley & Sons, Ltd.     

Predictors of Depressive Symptoms Among Children Affected by HIV in Rural China: A 3-Year Longitudinal Study

The current study was designed to examine the trend of depression among children affected by HIV (n = 1,221) in rural China over a period of 3 years and to explore baseline psychosocial factors that can predict depressive symptoms at 1- and 2-year follow-ups. Baseline depression score, trusting relationship with caregivers, perceived public stigma against children affected by HIV, and future expectation at baseline positively predicted the 1-year follow-up depression, while children’ self-report health status, self-esteem, and perceived social support negatively predicted depression at 1-year follow-up survey. Depression and self-report health status at baseline significantly predicted depression at the 2-year follow-up. The data in the current study suggested that depressive symptoms were chronic or recurring among some children affected by HIV/AIDS. The findings also underscore the importance of early identification, early intervention, and ongoing counseling for mental health problems among children affected by HIV/AIDS. Future psychological support programs need to target both mental health symptoms and resilient factors that will help these children to cope with adverse life events associated with HIV/AIDS.     

Content analysis of infanticide and neonaticide cases in the UK

Twenty cases, 14 infanticides and 6 neonaticides committed between 1989 and 2020 by biological mothers were analysed using Smallest Space Analysis for the presence of themes. Three themes associated with offender motivation were identified: Desperation, Disturbance and Rejection. Desperation theme included variables suggesting the mother committed the crime as a result of distress or perceived necessity. Disturbance suggested the motivation behind the offence to be as a result of the mother's caregiving role being disturbed; and the Rejection theme explained complete maternal rejection of the infant or new-born as the motivation behind the crime. Alongside the themes, three core variables were identified to be common for the crime regardless of motivation: the crime being committed at Home, the victim Female, and the crime being Denied by the mother. The implications of the findings are discussed including the potential for an investigative support tool and developing understandings of neonaticide and infanticide as separate crimes.     

Forced Retirement From Elite Football In Australia

Abstract

Retirement from sport poses a major socioemotional threat to elite athletes. The present study builds on a growing body of literature examining the vacuum created in an athlete's life after retirement. Grounded theory was used to construct how elite football players dealt with forced retirement owing to injury and deselection. Recursive in-depth interviews were conducted with 30 recently retired players who had competed at the highest level in Australian Rules football. The data were characterized by a rich array of personal reflections of loss and grief that reflected four themes: loss of identity, perceived control, financial issues, and social support. Interviewees typically told stories that were tinged with shock, regret, bitterness, distress, and perceived loss of status.     

Understanding general and specific connections between psychopathology and marital distress: a model based approach

Marital distress is linked to many types of mental disorders; however, no study to date has examined this link in the context of empirically based hierarchical models of psychopathology. There may be general associations between low levels of marital quality and broad groups of comorbid psychiatric disorders as well as links between marital adjustment and specific types of mental disorders. The authors examined this issue in a sample (N = 929 couples) of currently married couples from the Minnesota Twin Family Study who completed self-report measures of relationship adjustment and were also assessed for common mental disorders. Structural equation modeling indicated that (a) higher standing on latent factors of internalizing (INT) and externalizing (EXT) psychopathology was associated with lower standing on latent factors of general marital adjustment for both husbands and wives, (b) the magnitude of these effects was similar across husbands and wives, and (c) there were no residual associations between any specific mental disorder and overall relationship adjustment after controlling for the INT and EXT factors. These findings point to the utility of hierarchical models in understanding psychopathology and its correlates. Much of the link between mental disorder and marital distress operated at the level of broad spectrums of psychopathological variation (i.e., higher levels of marital distress were associated with disorder comorbidity), suggesting that the temperamental core of these spectrums contributes not only to symptoms of mental illness but to the behaviors that lead to impaired marital quality in adulthood.     

Mental health in infants with esophageal atresia

Chronic somatic illness in infancy may challenge the development of mental health and impinge the infant's capability to form close interpersonal relationships. Esophageal atresia (EA) is a congenital anomaly requiring neonatal surgery, medical aftertreatment, and extended hospitalization. The aim of the study was to assess mental health and to find prognostic factors for mental health among infants with EA. Thirty‐nine infants treated consecutively during 2000 to 2003 and their mothers were included. Infant mental health was assessed by Diagnostic Classification: 0–3 (Zero to Three, 1994). Medical and environmental data were collected from medical records and semistructured interview with the mothers. Child development was assessed with the Bayley scales, second edition (N. Bayley, 1993). Maternal psychological distress, anxiety, and child temperament were assessed by self‐report questionnaires: the General Health Questionnaire, 30‐item version (D. Goldberg & P. Williams, 1988); the State Trait Anxiety Inventory (C.D. Spielberger, R. Gorsuch, & R. Lushene, 1970); and the Infant Behaviour Questionnaire (M.K. Rothbart, 1981). Thirty‐one percent of the infants with EA showed mental health disorders by 1 year of age. Prognostic factors predicting mental health were posttraumatic symptoms reported by mother, more than one operation, mechanical ventilation beyond 1 day, and moderate/severe chronic family strain. Relational trauma, vulnerable attachment, and impaired self‐development are highlighted as possible pathways for psychopathology. Children with EA are vulnerable to mental health disorders, and this study may help clinicians to identify children at risk.     

The Complexity of Women’s Lives: Decision-making about Maternal HIV Disclosure

HIV/AIDS has reached epidemic levels in Washington, D.C. and mothers living with HIV increasingly have to make difficult decisions about whether or not to disclose their HIV status to their children. Focus groups were conducted with a sample of women (N = 15) living in Washington, D.C. to investigate maternal decision-making about HIV disclosure, the factors that influenced disclosure, challenges to disclosure, and children’s reactions to disclosure. This was a first step towards the larger goal of developing a culturally sensitive disclosure decision-making intervention. Participants were asked to identify elements to include in such an intervention. We also quantitatively examined participants’ psychosocial outcomes of depression, perceived social support, quality of life, and parenting challenges. Our preliminary findings showed that most participants experienced intense emotional distress after receiving an HIV diagnosis and this distress prevented them from disclosing their HIV status to family members and children. Several specific parenting concerns (e.g., age and gender of child, relationship to child, and number of children) influenced their decisions to disclose. All participants reported that HIV related stigma and discrimination as significant disclosure-related challenges. Health providers were not always perceived as being able to support participants in making a decision about whether or not to disclose their HIV status to their children.     

Foundations of generativity: Personal and family correlates of emerging adults’ generative life-story themes

Recently, the Eriksonian midlife personality strength of generativity has been described as existing in many forms and in persons of differing ages (McAdams, 2001). In this longitudinal study, narratives of life “turning points” and significant accomplishments were examined for generative themes in 32 adolescent/emerging adults (aged 16 and 20 years). We also explored these emerging adults’ volunteering behavior, prosocial reasoning, and parental influence as potential factors in generativity. Several parenting factors when adolescents were 16 (parents’ autonomy-encouraging practices, their emphasis on caring in stories of family value teaching, and adolescents’ reports of authoritative parenting style) were associated with more generative themes in narratives at age 20. Adolescents’ levels of prosocial reasoning, volunteering behavior, and personal value choices were also associated as expected with generative theme usage at age 20 in life stories, supporting the meaningfulness of this construct in emerging adulthood.